Methods for detecting lp-pla2 activity and inhibition of lp-pla2 activity

ABSTRACT

This invention relates to methods for determining the activity of Lp-PLA2 in at least one sample from an animal. The invention also relates to methods for determining the inhibition of Lp-PLA2 activity in samples from animals that are administered an Lp-PLA2 inhibitor.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. Ser. No. 12/817,677,filed on Jun. 17, 2010, which is a continuation of U.S. Ser. No.11/106,239, filed on Apr. 14, 2005, now U.S. Pat. No. 7,741,020, whichclaims benefit of U.S. Provisional Application No. 60/563,078, filedApr. 16, 2004, the entirety of which is incorporated by reference.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specificationare herein incorporated by reference in their entirety to the sameextent as if each individual publication or patent application wasspecifically and individually indicated to be incorporated by reference.

FIELD

This invention relates generally to methods and materials fordetermining lipoprotein-associated phospholipase A2 (herein “Lp-PLA2”)enzyme activity and inhibition of activity in tissue samples fromanimals.

BACKGROUND

Coronary heart disease (herein “CHD”) is the leading cause of death inmany industrial countries. Atherosclerosis is a form of arteriosclerosisor hardening of the arteries in which there is the progressive build-upof plaque containing cholesterol and lipids in blood arteries. Thisbuild-up is associated with an increased risk of heart disease andmorbid coronary events. The build-up of plaque in the arteries isassociated with an immune response that is triggered by damage to theendothelium. Initially, monocyte-derived macrophages accumulate at thedamaged site, due to the immune response causing a migration andaccumulation of smooth muscle cells which form fibrous plaque incombination with the macrophages, lipids, cholesterol, calcium salts andcollagen. The growth of such lesions can eventually block the artery andrestrict blood flow.

Lp-PLA2, also known as PAF acetylhydrolase, is a secreted,calcium-independent member of the growing phospholipase A2 superfamily(Tew, et al. (1996) Arterioscler Thromb Vasc Biol. 16(4):591-9;Tjoelker, et al. (1995) Nature 374(6522):549-53). It is produced bymonocytes, macrophages, and lymphocytes and is found associatedpredominantly with LDL (.about.80%) in human plasma. The enzyme cleavespolar phospholipids, including sn-2 ester of1-O-alkyl-2-scetyl-sn-glycero-3-phosphocholine, otherwise known asplatelet-activating factor (herein “PAF”) (Tjoelker, et al. (1995)Nature 374(6522):549-53).

Many observations have demonstrated a pro-inflammatory activity ofoxidized LDL when compared with native unmodified lipoproteins. One ofthe earliest events in LDL oxidation is the hydrolysis of oxidativelymodified phosphatidylcholine, generating substantial quantities oflysophosphatidylcholine (herein “lyso-PC”) and oxidized fatty acids.This hydrolysis is mediated solely by Lp-PLA2 (i.e., Lp-PLA2 hydrolyzesPAF to give lyso-phosphatidylcholine [herein “lyso-PC”] and acetate).(Stafforini, et al. (1997) J. Biol. Chem. 272, 17895)

Lyso-PC is suspected to be a pro-inflammatory and pro-atherogenicmediator. In addition to being cytotoxic at higher concentrations, it isable to stimulate monocyte and T-lymphocyte chemotaxis, as well asinduce adhesion molecule and inflammatory cytokine expression at moremodest concentrations. Lyso-PC has also been identified as the componentof oxidized LDL that is involved in the antigenicity of LDL, a featurethat may also contribute to the inflammatory nature of atherosclerosis.Moreover, lyso-PC promotes macrophage proliferation and inducesendothelial dysfunction in various arterial beds. The oxidized fattyacids that are liberated together with lyso-PC are also monocytechemoattractants and may also be involved in other biological activitiessuch as cell signaling). Because both of these products of Lp-PLA2hydrolysis are potent chemoattractants for circulating monocytes,Lp-PLA2 is thought to be responsible for the accumulation of cellsloaded with cholesterol ester in the arteries, causing thecharacteristic “fatty streak” associated with the early stages ofatherosclerosis.

Lp-PLA2 has also been found to be enriched in the highly atherogeniclipoprotein subfraction of small dense LDL, which is susceptible tooxidative modification. Moreover, enzyme levels are increased inpatients with hyperlipidaemia, stroke, Type 1 and Type 2 diabetesmellitus, as well as in post-menopausal women. As such, plasma Lp-PLA2levels tend to be elevated in those individuals who are considered to beat risk of developing accelerated atherosclerosis and clinicalcardiovascular events. Thus, inhibition of the Lp-PLA2 enzyme would beexpected to stop the buildup of this fatty streak (by inhibition of theformation of lysophosphatidylcholine), and so be useful in the treatmentof atherosclerosis.

Lp-PLA2 inhibitors inhibit LDL oxidation. Lp-PLA2 inhibitors maytherefore have a general application in any disorder that involves lipidperoxidation in conjunction with the enzyme activity, for example inaddition to conditions such as atherosclerosis and diabetes otherconditions such as rheumatoid arthritis, stroke, myocardial infarction(Serebruany, et al. Cardiology. 90(2):127-30 (1998)); reperfusion injuryand acute and chronic inflammation. In addition, Lp-PLA2 is currentlybeing explored as a biomarker of coronary heart disease (Blankenberg, etal. J Lipid Res. 2003 May 1) and arteriosclerosis (Tselepis and Chapman.Atheroscler Suppl. 3(4):57-68 (2002)). Furthermore, Lp-PLA2 has beenshown to play a role in the following disease: respiratory distresssyndrome (Grissom, et al. Crit. Care Med. 31(3):770-5 (2003);immunoglobulin A nephropathy (Yoon, et al. Clin Genet. 62(2):128-34(2002); graft patency of femoropopliteal bypass (Unno, et al. Surgery132(1):66-71 (2002); oral inflammation (McManus and Pinckard. Crit. RevOral Biol Med. 11(2):240-58 (2000)); airway inflammation andhyperreactivity (Henderson, et al. J Immunol. 15; 164(6):3360-7 (2000));HIV and AIDS (Khovidhunkit, et al. Metabolism. 48(12):1524-31 (1999));asthma (Satoh, et al. Am J Respir Crit. Care Med. 159(3):974-9 (1999));juvenile rheumatoid arthritis (Tselepis, et al. Arthritis Rheum.42(2):373-83 (1999)); human middle ear effusions (Tsuji, et al. ORL JOtorhinolaryngol Relat Spec. 60(1):25-9 (1998)); schizophrenia (Bell, etal. Biochem Biophys Res Commun. 29; 241(3):630-5 9 (1997)); necrotizingenterocolitis development (Muguruma, et al. Adv Exp Med. Biol.407:379-82 (1997)); and ischemic bowel necrosis (Pediatr Res.34(2):237-41 (1993)).

Lp-PLA2 activity from human tissue samples has been measured usingspectrophotometric activity and fluorogenic activity assays (CaymanChemical Company, and Karlan Research Products). See also Kosaka, et al.Clin Chem Acta 296(1-2):151-61 (2000) and Kosaka, et al. Clin Chem Acta312(1-2):179-83 (2001). For instance, Azwell, Inc. (Osaka, Japan)reported in 2000 the synthesis and use of1-myristoyl-2-(p-nitrophenylsuccinyl) phosphatidylcholine as acolorimetric substrate for measurement of human PAF AH (Lp-PLA2)activity in plasma and serum. In 2002, Azwell launched itsresearch-use-only Auto PAF AH assay kit that utilizes this substrate andis formatted for use in a clinical chemistry analyzer. These methods maybe capable of detecting inhibition of Lp-PLA2 activity when an inhibitorof Lp-PLA2 is added to a tissue sample in vitro. However, the methodsprovided with the Auto PAF AH assay are insensitive to measuringinhibition of Lp-PLA2 activity when an inhibitor of Lp-PLA2 has beenadministered to an animal prior to tissue sample collection.

In order to measure Lp-PLA2 activity in the presence of inhibitor in atissue sample obtained from an animal administered inhibitor, anactivity protocol is required.

Accordingly, methods for determining LP-PLA2 activity and inhibitionfrom a tissue sample obtained from an animal that has been administeredan Lp-PLA2 inhibitor are greatly needed. Thus, there is a need forcolorimetric or fluorometric methods and assays for accurately detectinginhibition of Lp-PLA2 activity, particularly with a sufficient dynamicrange.

None of the existing assays described above can provides a colorimetricor fluorometric method that is able to reliable detect greater then 30%inhibition of Lp-PLA2 activity in an animal (including humans) that hasbeen administered an inhibitor of Lp-PLA2. As described in more detailbelow, prior art colorimetric or fluorometric methods (assays) fordetecting Lp-PLA2 activity (spectrophotometric assays) are insensitiveto the inhibition of Lp-PLA2, and typically indicate less than 30% ofinhibition of LpPLA2 even in the presence of high levels of inhibitor.Further, none of these colorimetric or fluorometric assays can detectLp-PLA2 activity/inhibition with a 100-fold or greater dynamic range.Described herein are methods and assays which may address these needs.

SUMMARY OF THE DISCLOSURE

In general, described herein are methods and assays for colorimetricallyor fluorometrically detecting Lp-PLA2 inhibition (and particularlyaccurately reflecting up to 75% inhibition or more).

For example, described herein is a colorimetric or fluorometric methodof determining the percentage of inhibition of Lp-PLA2 activity. Themethod may include: colorimetrically or fluorometrically detectingLp-PLA2 activity from a first blood sample that is taken from thesubject at a first time and diluted less than 33 times; colorimetricallyor fluorometrically detecting Lp-PLA2 activity from a second bloodsample that is taken from the subject at a second time one hour or moreafter the first time and diluted less than 33 times; and detectinggreater than 30% inhibition of Lp-PLA2 activity between the first andsecond blood samples by comparing the activity of the Lp-PLA2 betweenthe first and second blood samples, indicating that the subject hastaken a drug that inhibits Lp-PLA2.

Any of the detection steps may colorimetrically or fluorometricallydetect Lp-PLA2 activity by the use of a relatively low dilution of thesample (e.g., less than 50 fold, less than 45 fold, less than 40 folk,less than 35 fold, less than 33 fold, less than 30 fold, etc.) dilutionof sample in the assay. The detection step may include the use of asubstrate having a colormetric or fluorometric moiety. For example,preparing a solution may comprise preparing a solution including asubstrate for Lp-PLA2 having a colorimetric or fluorometric detectablemoiety.

The second blood sample may be taken (e.g., from the same subject) afterthe subject has been administered a drug that inhibits Lp-PLA2. Any ofthese detection steps may be performed after 0.5 hours, after 0.6 hours,0.7 hours, 0.8 hours, 0.9 hours, 1 hour, 1.5 hours, etc., after thesubject or sample has been exposed to the inhibitor, to detect greaterthan 30% inhibition.

In some variations, the step of detecting greater than 30% inhibition ofLp-PLA2 activity comprises detecting greater than 70% inhibition (afterone hour), as illustrated in Table 7 and Table 9, below, or detectinggreater than 75%, greater than 80%, greater than 85%, greater than 90%,etc. inhibition of Lp-PLA2, between the first and second blood samples(e.g., between inhibitor-free and inhibitor-exposed samples). Thepercent inhibition may also be measured with respect to a standardactivity level (for a population, or a representative population,relative to the subject), rather than by comparing inhibitor-free andafter-exposed to inhibitor in the same patient. Instead, theinhibitor-free values used to determine the percent inhibition may bebased on one or more standards.

The step of detecting greater than 30% inhibition of Lp-PLA2 activitymay comprise detecting at least or exactly 85-95% inhibition of Lp-PLA2between the first and second blood samples.

Any appropriate tissue sample may be used, including in particular,blood samples, such as samples of blood plasma or blood serum samples.The sample may be fresh or frozen (thawed).

As mentioned, in general the methods described herein comprisecolorimetrically or fluorometrically detecting Lp-PLA2 activity from thefirst and second blood samples by detecting Lp-PLA2 activity within adynamic range of 100-fold or greater.

For example, a method of clinically monitoring a patient to assess theefficacy of an inhibitor of lipoprotein-associated phospholipase A2(Lp-PLA2) may include: receiving a sample from an animal that has beenadministered an Lp-PLA2 inhibitor; and colorimetrically orfluorometrically detecting greater than 30 percent inhibition of Lp-PLA2from the sample by contacting the sample with a solution comprising asubstrate for Lp-PLA2. Colorimetrically or fluorometrically detectingmay comprise detecting inhibition of Lp-PLA2 from a plurality of samplesobtained from the animal at one or more than one time point before andafter administration of Lp-PLA2 inhibitor. For example, colorimetricallyor fluorometrically detecting may comprise comparing the activity ofLp-PLA2 from a plurality of samples including at least one sampleobtained from the animal prior to the administration of Lp-PLA2inhibitor.

In general, in any of these methods, the substrate concentration may bebetween about 53 μM to about 1125 μM. Alternatively or additionally, thesubstrate concentration may be less than 10 times the Km of Lp-PLA2 forthe given substrate.

For example, described herein are methods of determining inhibition oflipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme activity from asample, the method comprising: preparing a solution comprising asubstrate for Lp-PLA2; contacting a sample from an animal that has beenadministered an Lp-PLA2 inhibitor, wherein the sample is diluted lessthan a 33 fold by contact with the solution; and colorimetrically orfluorometrically detecting Lp-PLA2 activity. Colorimetrically orfluorometrically detecting Lp-PLA2 activity may comprise detectinggreater than 30 percent inhibition (e.g., at least 85-95% inhibition).

For example, described herein are colorimetric or fluorometric methodsof detecting greater than 30% inhibition of lipoprotein-associatedphospholipase A2 (Lp-PLA2) enzyme, the method comprising: preparing asolution comprising a substrate for Lp-PLA2; contacting a sample from ananimal that has been administered an Lp-PLA2 inhibitor, wherein thesample is diluted less than 33-fold; colorimetrically orfluorometrically detecting Lp-PLA2 activity. Colorimetrically orfluorometrically detecting Lp-PLA2 activity may comprise detecting atleast 85-95% inhibition.

For example, in one aspect of the present invention, a method isprovided for determining inhibition of Lp-PLA2 enzyme activity in atleast one tissue sample comprising the steps of preparing a solutioncomprising a substrate for Lp-PLA2 comprising a colorimetric orfluorometric detectable moiety; contacting at least one said tissuesample with the solution of the preparing step; and detecting Lp-PLA2activity, wherein the tissue sample is from an animal that has beenadministered with Lp-PLA2 inhibitor.

In another example of the current invention, a method is provided fordetermining Lp-PLA2 enzyme activity in a tissue sample obtained from ananimal comprising the steps of: a) contacting 110 μL of a solutioncomprising: a solution comprising 90 mM1-myristoyl-2-(4-nitrophenylsuccinyl) phosphatidylcholine contacted witha solution comprising 200 mM HEPES, 200 mM NaCl, 5 mM EDTA, 10 mM CHAPS,10 mM sodium 1-nonanesulfonate at a pH 7.6 in a ratio of 0.66 μL to 110μL; with at least one 25 μL tissue sample from an animal; with 25 μLeach of a p-nitrophenol standard solution comprising; 4, 3, 2, 1, 0.4 or0.2 nmol/μL p-nitrophenol in methanol; and 25 μL of phosphate bufferedsaline (PBS) or ddH₂O to make a blank; and b) determining Lp-PLA2activity.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe claims that follow. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1 illustrates one example of an Lp-PLA2 substrate that can bespectrophotometrically monitored at 405 nm to detect Lp-PLA2 activity.

FIG. 2 is Table 1, showing the measurement of Lp-PLA2 activity inpatients who received inhibitor in vivo using a radiometric assay and an“Auto PAF AH Assay” (prior art) at time points from 0 (beforeadministration of the inhibitor) to 144 hrs after administering theinhibitor. The radiometric assay, while expensive and difficult toperform, accurately indicates inhibition of Lp-PLA2 activity over time,while the Auto PAF AH Assay does not detect inhibition.

FIG. 3 is Table 2, showing Lp-PLA2 activity (nmol/min/nL) in patientswho received placebo and inhibitor in vivo, using a radiometric and AutoPAF AH (prior art) assay.

FIGS. 4A, 4B and 4C illustrate chemical formulas I, II and III,respectively. Formulas I, II and II are examples of Lp-PLA2 inhibitors.Formula I is 2-(2-(3,4-Difluorophenyl)ethyl)-1H-quinoline-4-1-ylN-(4′-trifluoromethylbiphenyl-4-ylmethyl)-acetamide bitartrate; ispresented below and is described in WO 02/30904. Formula II is1-(N-(2-(Diethylamino)ethyl)-N-(4-(4-trifluoromethylphenyl)benzyl)-aminoc-arbonylmethyl)-2-(4-fluorobenzyl)thio-5,6-trimethylenepyrimidin-4-onebitartrate, and is described in WO 01/60805. Formula III is1-(N-(2-(Diethylamino)ethyl)-N-(4-(4-trifluoromethylphenyl)benzyl)aminoca-rbonylmethyl)-2-(4-fluorobenzypthio-5-(1-methylpyrazol-4-ylmethyl)pyrimid-in-4-oneis described in WO 00/66567.

FIG. 5 is Table 3, showing inhibitor of Lp-PLA2 activity as measured byAuto PAF AH and low throughput radiometric assay, showing the inabilityof the Auto PAF AH assay to detect inhibition of LpPLA2 activity, whichis detectable in the radiometric assay.

FIG. 6 is Table 4, showing the in vitro inhibition of LpPLA2 activity byFormula III, as detected with one variation of a drug-sensitivecolorimetric Lp-PLA2 activity assay as described herein.

FIG. 7 is Table 5, showing the effect of detergent on substratespecificity for one variations of a drug-sensitive colorimetric Lp-PLA2activity assay.

FIG. 8 is Table 6, showing a comparison of the standard radiometricassay and one variation of a drug-sensitive colorimetric Lp-PLA2activity assay.

FIG. 9 is Table 7, showing a percent inhibition of Lp-PLA2 Activity inplasma samples from subjects administered an Lp-PLA2 inhibitor,comparing a radiometric assay, the Auto PAF Drug-Sensitive Assay, andone variation of a drug-sensitive colorimetric Lp-PLA2 activity assay.The drug-sensitive colorimetric Lp-PLA2 activity assay was able todetect greater than 30% inhibition of the Lp-PLA2 due to the inhibitor,in all subjects after 1 hour following administration, whereas the AutoPAF AH assay was not able to detect greater than 16% inhibition.

FIG. 10 is Table 8, showing Lp-PLA2 activity in plasma samples fromsubjects administered an Lp-PLA2 inhibitor, showing a comparison betweena radiometric assay, the Auto PAF AH assay and an example of adrug-sensitive colorimetric Lp-PLA2 activity assay.

FIGS. 11 (part 1), 11 (part 2) and 11 (part 3) are Table 9, showingLp-PLA2 activity and percent inhibition by subject and assay andcomparing the results for the radiometric, auto PAF AH and an example ofa drug-sensitive colorimetric Lp-PLA2 activity assay. The adrug-sensitive colorimetric Lp-PLA2 method was sensitive to inhibitionof Lp-PLA2, as was the radiometric assay method, and was able to showgreater than 30% inhibition (and greater than 75-80% inhibition,particularly after 1 hour post-administering of the inhibitor; incontrast the Auto PAF AH assay appeared insensitive to the inhibitionand indicated a maximum of about 28.6% inhibition.

FIG. 12 is Table 10, showing the detection of activity of recombinanthuman Lp-PLA2 protein using a modified colorimetric assay (e.g., adrug-sensitive colorimetric Lp-PLA2 activity assay). In Table 10, therange of activity values for the drug-sensitive colorimetric Lp-PLA2activity assay also indicates the dynamic range of the method, which isgreater than 100-fold and is up to almost 700-fold (>690-fold).

FIG. 13 is Table 11, showing the activity of purified human Lp-PLA2enzyme determined using a drug sensitive colorimetric Lp-PLA2 activityassay. As in Table 10, the dynamic range of the method is greater than100-fold.

FIG. 14 is Table 12, showing the effect of preincubation of plasma inbuffer R1 on percent inhibition of Lp-PLA2 activity in a drug-sensitivecolorimetric Lp-PLA2 activity assay.

FIG. 15 is Table 13, showing the effect of substrate concentration onpercent inhibition of Lp-PLA2 activity in a drug-sensitive colorimetricLp-PLA2 activity assay.

FIG. 16 is Table 14, showing the effect of sample volume on percentinhibition of Lp-PLA2 activity in a drug-sensitive colorimetric Lp-PLA2activity assay.

FIG. 17 is Table 15, showing the effect of the removal of buffer R2Afrom the assay (e.g., in the absence of a substrate stabilizer, such ascitric acid, which improved the assay in relation to other colorimetricassays such as the Auto PAF AH assay).

FIG. 18 is Table 16, showing the effect of substrate concentration onVmax of substrate hydrolysis Vmax (milliOD/min) of substrate hydrolysisin absence of buffer R2A.

FIG. 19 is Table 17, showing the effect of reaction time on reactionrate under different plasma volume and substrate concentrations.

FIG. 20 is Table 18, showing the results of intra-assay validation for adrug-sensitive colorimetric Lp-PLA2 activity assay.

FIG. 21 is Table 19, showing the results of inter-assay validation for adrug-sensitive colorimetric Lp-PLA2 activity assay.

FIG. 22 is Table 20, showing inter-operator variability for adrug-sensitive colorimetric Lp-PLA2 activity assay.

FIG. 23 is Table 21, showing the effect of freezing/thawing in adrug-sensitive colorimetric Lp-PLA2 activity assay.

FIG. 24 is Table 22, showing detection of inhibition of Lp-PLA2 usingvariations of drug-sensitive colorimetric Lp-PLA2 activity assays (atthree different substrate concentrations, 440 μM substrate/25 μL plasma,112 μM substrate/25 μL plasma, and 112 μM substrate/45 μL plasma).

FIG. 25 is Table 23, showing the detection of inhibition with variationsof drug-sensitive colorimetric Lp-PLA2 activity assays.

FIG. 26 is Table 24, showing the results of assays of recombinant humanLp-PLA2 using 112 μM substrate/45 μL plasma in a drug-sensitivecolorimetric Lp-PLA2 activity assay.

FIG. 27 is Table 25, showing the effect of reaction time user foractivity calculation on assay dynamic range for a variation of adrug-sensitive colorimetric Lp-PLA2 activity assay.

FIG. 28 is Table 26, showing the effect of Lp-PLA2 activity in ten serumsamples using a drug-sensitive colorimetric Lp-PLA2 activity assay.

FIG. 29 is Table 27, showing in vitro drug inhibition of serum Lp-PLA2activity using a drug-sensitive colorimetric Lp-PLA2 activity assay.

DETAILED DESCRIPTION Glossary

“Animal” as used herein includes any human or non-human mammal, or anyother vertebrate capable of naturally producing an enzyme having Lp-PLA2activity, including Lp-PLA2, Lp-PLA2-homologs or orthologs thereof.

“Clinical trial” means human clinical trial.

“Lp-PLA2 enzyme activity” as used herein includes, but is not limitedto, any enzyme activity of Lp-PLA2. This activity may include but is notlimited to an Lp-PLA2 enzyme binding substrate, releasing product,and/or hydrolyzing phospholipids or other molecules.

“Polypeptide(s)” refers to any peptide or protein comprising two or moreamino acids joined to each other by peptide bonds or modified peptidebonds. “Polypeptide(s)” refers to both short chains, commonly referredto as peptides, oligopeptides and oligomers and to longer chainsgenerally referred to as proteins. Polypeptides may comprise amino acidsother than the 20 gene encoded amino acids. “Polypeptide(s)” comprisethose modified either by natural processes, such as processing and otherpost-translational modifications, but also by chemical modificationtechniques. Such modifications are well described in basic texts and inmore detailed monographs, as well as in a voluminous researchliterature, and they are well known to those of skill in the art. Itwill be appreciated that the same type of modification may be present inthe same or varying degree at several sites in a given polypeptide.Also, a given polypeptide may comprise many types of modifications.Modifications can occur anywhere in a polypeptide, including the peptidebackbone, the amino acid side-chains, and the amino or carboxyl termini.Modifications comprise, for example, acetylation, acylation,ADP-ribosylation, amidation, covalent attachment of flavin, covalentattachment of a heme moiety, covalent attachment of a nucleotide ornucleotide derivative, covalent attachment of a lipid or lipidderivative, covalent attachment of phosphotidylinositol, cross-linking,cyclization, disulfide bond formation, demethylation, formation ofcovalent cross-links, formation of cysteine, formation of pyroglutamate,formylation, gamma-carboxylation, GPI anchor formation, hydroxylation,iodination, methylation, myristoylation, oxidation, proteolyticprocessing, phosphorylation, prenylation, racemization, glycosylation,lipid attachment, sulfation, gamma-carboxylation of glutamic acidresidues, hydroxylation and ADP-ribosylation, selenoylation, sulfation,transfer-RNA mediated addition of amino acids to proteins, such asarginylation, and ubiquitination. See, for instance, PROTEINS—STRUCTUREAND MOLECULAR PROPERTIES, 2nd Ed., T. E. Creighton, W.H. Freeman andCompany, New York (1993) and Wold, F., Posttranslational ProteinModifications Perspectives and Prospects, pgs. 1-12 in POSTTRANSLATIONALCOVALENT MODIFICATION OF PROTEINS, B. C. Johnson, Ed., Academic Press,New York (1983); Seifter et al., Meth. Enzymol. 182:626-646 (1990) andRattan et al., Protein Synthesis: Posttranslational Modifications andAging, Ann. N.Y. Acad. Sci. 663: 48-62 (1992). Polypeptides may bebranched or cyclic, with or without branching. Cyclic, branched andbranched circular polypeptides may result from post-translationalnatural processes and may be made by entirely synthetic methods, aswell.

“Filtration” or “filtering” as used herein includes, but is not limitedto, the removal of any substance from a solution and may comprisepassing a solution containing the substance to be removed through filterpaper, Whatman paper, cheese cloth, or a column that selectively removessaid substance from solution based on its physical and/or chemicalcharacteristics. Physical and chemical characteristics that may be usedto remove a substance through filtration may include, but are notlimited to, ionic charge, size, weight, polarity, and/or chemicalmoieties associated with the substance that make it likely to bind tothe material filling the column. Filtration may comprise using gravity,vacuum, and/or centrifugation to facilitate the removal of saidsubstance from solution.

“Scintillation cocktail” as used herein is a mixture of solutes andsolvents, typically containing an organic solvent capable ofsolubilizing and maintaining a uniform suspension of a tissue sample forliquid scintillation. The process of liquid scintillation involves thedetection of beta decay within a sample via capture of beta emissions. Ascintillation cocktail mixture is designed to capture the beta emissionand transform it into a photon emission which can be detected via aphotomultiplier tube within a scintillation counter. Severalscintillation cocktails are commercially available. It is understoodthat a modification of the composition of the scintillation cocktail caneffect and/or optimize the detectable reading from liquid scintillationdepending on the sample.

“Tissue(s)” as used herein comprises serum, cell lysate, tissue lysate,urine, blood plasma, plaque, monocytes, or macrophage cells. Thesetissues can be from humans, non-human mammals or other animals thatnaturally produces and enzyme having Lp-PLA2 activity, includingLp-PLA2, Lp-PLA2-homologs or orthologs thereof.

“Colorimetric or fluorimetric detectable moiety” as used herein is aportion of a compound capable of producing a detectable or measurablesignal. Such a signal may be measurable by, but not limited to, visiblelight emission or absorption, fluorescence, phosphorescence or otherdetectable quanta. For instance, a substrate for Lp-PLA2 may comprise acolorimetric c moiety bonded to phosphatidylcholine at the Lp-PLA2cleavage site. When Lp-PLA2 cleaves the colorimetric moiety fromphosphatidylcholine the colorimetric moiety emits a detectable signal asvisible light. One non-limiting example of phosphatidylcholine bonded toa colorimetric moiety is 1-myristoyl-2-(4-nitrophenylsuccinyl)phosphatidylcholine.

Lp-PLA2 “inhibitor” or “inhibition” as used herein refers to any method,technique, condition, or compound capable of reducing or eliminatingLp-PLA2 activity, including but not limited to reducing or eliminatingany of the activities of Lp-PLA2 including, but not limited to, enzymebinding substrate, releasing product, and/or hydrolyzing phospholipidsor other molecules. Inhibition of Lp-PLA2 activity may be measured in asample obtained from an animal administered an inhibitor, which isconsidered in vivo administration. Alternatively, an inhibitor may beadded to a sample after it is obtained from an animal, which would beconsidered in vitro administration.

An inhibitor of Lp-PLA2 may include any appropriate inhibitor ofLp-PLA2, including Formulas I, II, III, described in greater detailbelow, or any other direct or indirect inhibitor of Lp-PLA2. Forexample, Darapladib (SB-480848), shown in Formula II, below, is aselective Lp-PLA2 inhibitor of Lp-PLA2. Diralapid, Rilapladib (shown inFormula I, below) and generally quinolone compounds (see, e.g., U.S.Pat. No. 8,575,348) and pyrimidinone compounds inhibit Lp-PLA2 (see,e.g., U.S. Pat. No. 8,637,524). Other inhibitors may include HMG-CoAreductase inhibitors (statins), including, but not limited to,atorvastatin, cerivastatin, fluvastatin, lovastatin, mevastatin,pitavastatin, pravastatin, rosuvastatin, and simvastatin. Niacin andezetimibe((3R,4S)-1-(4-fluorophenyl)-3-[(3S)-3-(4-fluorophenyl)-3-hydroxypropyl]-4-(4-hydroxyphenyl)azetidin-2-one),have also been identified as an inhibitors of Lp-PLA2. Other Lp-PLA2inhibitors may include fibrates, both alone or in combination withorlistat ((S)-((S)-1-((2S,3S)-3-Hexyl-4-oxooxetan-2-yl)tridecan-2-yl)2-formamido-4-methylpentanoate), e.g., fenofibrate (propan-2-yl2-{4-[(4-chlorophenyl)carbonyl]phenoxy}-2-methylpropanoate), andgemfibrozil (5-(2,5-dimethylphenoxy)-2,2-dimethyl-pentanoic acid).Additionally, inhibitors may include PCSK9 inhibitors, including, butnot limited to, alirocumab (REGN727), LGT209, evolocumab (AMG145),bococizumab (PF-04950615, RN316), RG-7652 (Roche/Genentech), LY3015014(Eli Lily), ALN-PCS/02 (Alnylam Pharmaceuticals), BMS-962476(Bristol-Myers Squibb), SPC5001 (Santaris Pharma A/S),BMS-844421/ISIS-405879 (Bristol-Myers Squibb/Isis Pharmaceuticals).Inhibitors additionally may include omega-3 fatty acids, compoundscontaining resolvins, and foods with high omega-3 fatty acids,including, but not limited to, omega-3 rich fish oils, salmon, andsardines. Inhibitors may include foods high in anti-oxidant compounds,including, but not limited to, fresh fruits and vegetables, beans, nuts,seeds, tea, red wine, pomegranate juice, and tumeric (curcumin).Inhibitors may further include foods with high flavonoid content (e.g.dark chocolate). Inhibitors may additionally include combinations ofinhibitors and molecules with the properties of multiple inhibitors,including, but not limited to, CAT 2003 (a conjugate of niacin and theomega 3 fatty acid eicosapentaenoic acid (EPA); CatabasisPharmaceuticals).

As used herein, “reduce” or “reducing” refers to a decrease orelimination in Lp-PLA2 enzyme activity. Some non-limiting examples forthe purposes of measuring reduced Lp-PLA2 activity include measuringLp-PLA2 activity from the same animal in the presence and absence of aninhibitor of Lp-PLA2 activity. Alternatively, Lp-PLA2 activity can bemeasured against a standard recombinantly expressed, semi-purified orpurified enzyme.

As used herein “free” or “essentially free” of Lp-PLA2 inhibitor refersto a tissue sample that contains either no Lp-PLA2 inhibitor or Lp-PLA2inhibitor at a low enough concentration such that Lp-PLA2 activity isnot inhibited by the inhibitor. For instance, if the inhibitor ispresent at a concentration lower than the determined dissociationconstant of that inhibitor for Lp-PLA2, a tissue sample may beconsidered essentially free of inhibitor. A tissue sample may beconsidered free of Lp-PLA2 inhibitor if it is obtained from an animalprior to administration of an Lp-PLA2 inhibitor that is not producednaturally by the animal. A tissue sample may also be considered free oressentially free of an Lp-PLA2 inhibitor if it is obtained from ananimal at a time after the last dose of inhibitor sufficient to ensureclearance based on pharmacokinetic profile of that inhibitor in thespecies of animal.

Lp-PLA2 is a known hydrolyzer of phospholipids. Lp-PLA2 can cleavephospholipids at the sn-2 position to create lyso-PC and oxidized fattyacids. PAF has a two-carbon acyl group at the sn-2 position; therefore,when PAF is hydrolyzed by Lp-PLA2, the short acyl group is cleaved aswater soluble acetate from the remainder of the molecule, which islyso-PC. A substrate possessing a colorimetric or fluorimetric moietycan be used to measure Lp-PLA2 activity. For instance, as illustrated inFIG. 1, the substrate,1-myristoyle-2-(p-nitrophenylsuccinyl)-phosphatidylcholine, is a PAFanalogue with a 4-nitrophenyl group conjugated onto a succinyl chain atsn-2 position. Lp-PLA2 (PAF-AH) hydrolyzes the sn-2 position of thesubstrate, producing 4-nitrophenyl succinate. This liberation can bespectrophotometrically monitored at 405 nm and Lp-PLA2 activitydetermined from the change in absorption.

The methods of the present invention have been shown to demonstrate acorrelation between Lp-PLA2 inhibitor concentration in a tissue sampleand Lp-PLA2 activity in vitro. Furthermore, the present inventionprovides methods for measuring Lp-PLA2 activity over time in tissuesamples from animals treated with Lp-PLA2 inhibitor. These data may becorrelated with the pharmacokinetic profile of inhibitor from an animal,such as a human.

A colorimetric Lp-PLA2 activity monitoring assay has been developedusing 1-myristoyl-2-(p-nitrophenylsuccinyl) phosphatidylcholine as thesubstrate. In vitro drug inhibition study using Lp-PLA2-specificinhibitors showed specificity of this substrate against Lp-PLA2.However, the Auto PAF A11 assay provided by Azwell failed to detect druginhibition in human subjects who received Lp-PLA2 inhibitor drugs invivo, although the same substrate and the same buffer condition are usedin the assays developed herein. Factors such as pre-incubation of plasmawith assay buffer, plasma sample volume, substrate concentration, anduse of buffer R2A, have been identified to contribute to in vitro drugdissociation in the assay and in turn cause the inability of the assayto detect drug inhibition in in vivo drug-bound tissue samples. Thesefactors therefore were modified in development of new, drug-sensitivecolorimetric Lp-PLA2 activity assays. Interactions between these factorshave also been studied so that assay conditions could be chosen thatwould generate detectable in vivo drug inhibition and also offer anadequate assay dynamic range. Unlike prior art assays, the modifieddrug-sensitive assays described herein are able to detect inhibition andregister greater than 30% inhibition at a reasonably broad dynamic range(e.g., 100-fold or greater). For example, the modified drug-sensitiveassays described herein able to detect 85-95% (or more) drug inhibitionin human subjects with in vivo administration of Lp-PLA2 inhibitors andtherefore could be used as a monitoring assay to assess drug efficacy inthe clinic. These assays also offer a dynamic range of close to 100-fold(in the examples described below, a dynamic range of greater than100-fold, such as greater than 600-fold, are shown) and potentially isalso useful as a screening assay that is capable of measurement of abroader range of Lp-PLA2 activity.

In one aspect of the present invention, a method is provided fordetermining inhibition of Lp-PLA2 enzyme activity in at least one tissuesample comprising the steps of preparing a solution comprising asubstrate for Lp-PLA2 comprising a colorimetric or fluorometricdetectable moiety; contacting at least one said tissue sample with thesolution of the preparing step; and detecting Lp-PLA2 activity, whereinthe tissue sample is from an animal that has been administered withLp-PLA2 inhibitor. These methods may further comprise comparing Lp-PLA2activity from a tissue sample obtained from an animal prior to Lp-PLA2inhibitor administration or that is free of Lp-PLA2 inhibitor.Inhibition of Lp-PLA2 activity may be measured in a plurality of tissuesamples obtained from an animal at more than one time point afteradministration of said Lp-PLA2 inhibitor. The substrate may be1-myristoyl-2-(4-nitrophenylsuccinyl) phosphatidylcholine and may beused at a concentration of about 53 μM to about 1125 μM. Theconcentration of -myristoyl-2-(4-nitrophenylsuccinyl)phosphatidylcholine may be 440 μM or it may be 112 μM.

In one aspect of the invention, the tissue sample may be blood plasma,or it may be serum. In another aspect, the blood plasma is diluted about3 to 9 fold with the solution of the preparing. Lp-PLA2 activity may bemeasured by measuring optical density of the tissue sample.

In another aspect of the present invention, the solution comprising asubstrate for Lp-PLA2 further comprises a buffer and wherein the bufferis incubated with the substrate prior to contacting the substrate withsaid tissue sample. In another aspect, the buffer does not comprisecitric acid monohydrate. In another aspect, the substrate concentrationis maintained at approximately the Km of said substrate. Km of saidsubstrate may be decreased by removing citric acid monohydrate from thebuffer. When the substrate is 1-myristoyl-2-(4-nitrophenylsuccinyl)phosphatidylcholine, the substrate concentration may be about 440 μM ormay be about 112 μM.

In another aspect of the present invention, the volume of plasma sampleis about 15 μL to about 50 μL in a volume of about 125 μL to about 170μL of the solution of the preparing step. In another aspect, the pH ofthe reaction is maintained at least about 7.5 prior to contacting theplasma sample with the solution of the preparing step.

In another embodiment of the present invention, a method is provided fordetermining Lp-PLA2 enzyme activity in a tissue sample obtained from ananimal comprising the steps of: a) contacting 110 μL of a solutioncomprising: a solution comprising 90 mM1-myristoyl-2-(4-nitrophenylsuccinyl) phosphatidylcholine contacted witha solution comprising 200 mM HEPES, 200 mM NaCl, 5 mM EDTA, 10 mM CHAPS,10 mM sodium 1-nonanesulfonate at a pH 7.6 in a ratio of 0.66 μL to 110μL; with at least one 25 μL tissue sample from an animal; with 25 μLeach of a p-nitrophenol standard solution comprising; 4, 3, 2, 1, 0.4 or0.2 nmol/μL p-nitrophenol in methanol; and 25 μL of phosphate bufferedsaline (PBS) or ddH₂O to make a blank; and b) determining Lp-PLA2activity.

In one aspect, the tissue sample from animal is blood plasma. In anotheraspect, the animal is human. In yet another aspect, the animal has beenadministered an inhibitor of Lp-PLA2 prior to obtaining the tissuesample. Inhibition of Lp-PLA2 enzyme activity by said Lp-PLA2 inhibitoradministered prior to obtaining said tissue sample is measured bycomparing Lp-PLA2 activity of a tissue sample free of said Lp-PLA2inhibitor.

In another embodiment of the present invention, a method is provided fordetermining Lp-PLA2 enzyme activity in a tissue sample obtained from ananimal wherein enzyme activity is determined by: a) generating astandard curve by plotting optical density (OD) values at 405 nm for thep-nitrophenol standard solutions vs. p-nitrophenol (nmol/well); b)calculating the slope (OD/nmol) of the standard curve; c) calculatingabsorbance change between 3 and 1 minute (ΔOD_(3min−1min)) for bothsolutions comprising tissue samples and blank; and d) calculatingLp-PLA2 activity using the following formula:

Lp-PLA2activity(nmol/min/ml)=(ΔOD_(sample)−ΔOD_(blank))/slope(OD/nmol)/0.025ml=2 minutes.

In another embodiment of the present invention, a method is provided fordetermining Lp-PLA2 enzyme activity in a tissue sample obtained from ananimal comprising the steps of: a) preparing a solution comprising 200mM HEPES, 200 mM NaCl, 5 mM EDTA, 10 mM CHAPS, 10 mM sodium1-nonanesulfonate at a pH 7.6; b) preparing a solution comprising 90 mM1-myristoyl-2-(4-nitrophenylsuccinyl) phosphatidylcholine; c) preparing100, 75, 50, 25, 10 and 5 nmol/μL stock solutions of p-nitrophenol inmethanol; d) preparing working solutions for p-nitrophenol standards bydiluting 40 μL of stock solutions of step c into 960 μL of methanol; e)contacting the solution of step b and the solution of step a in a ratioof 0.66 μL to 110 μL to make an assay buffer; f) adding 120 μL of assaybuffer to each well in a 96-well V-bottom plate; g) adding 25 μL of eachp-nitrophenol standard working solution of step d into a separate wellof two columns of a 96-well flat-bottom plate; h) adding 25 μL of tissuesample from an animal per well that do not contain p-nitrophenolstandards of the flat-bottom plate of step g; i) adding 25 μL of PBS ordd H₂O into an empty well in the flat-bottom plate for use as a blank;j) contacting 110 μL of assay buffer from the V-bottom plate to eachwell of the flat-bottom assay plate; k) placing the flat bottom assayplate onto a plate reader and reading at 405 nm; 1) generating astandard curve by plotting optical density (OD) values for the standardsolutions vs. p-nitrophenol (nmol/well); m) calculating the slope(OD/nmol) of the standard curve; n) calculating absorbance changebetween 3 and 1 minutes (ΔOD_(3min−1min)) for both test samples and theblank; and o) calculating Lp-PLA2 activity using the following formula:

Lp-PLA2activity(nmol/min/ml)=(ΔOD_(sample)−ΔOD_(blank))/slope(OD/nmol)/0.025ml/2 minutes.

Calculating the absorbance change can be performed at various intervalsincluding, but not limited to, 2 and 0 minutes, 1 and 0 minutes andabout 15-second intervals measured over about a 10 minute reaction time.

The following examples illustrate various aspects of this invention.These examples do not limit the scope of this invention which is definedby the appended claims.

EXAMPLES

Unless otherwise indicated all plasma samples were collected from humanand are human plasma. Unless otherwise indicated, plasma samples for thefollowing examples were collected as follows. Blood was collected intoEDTA-containing tubes. The tubes were centrifuged at 1730*g for 10minutes. Plasma was drawn off with transfer pipettes into tubes andstored at −80° C.

In experiments in which Lp-PLA2 inhibitor was added to tissue samples invitro the following procedure was used, unless otherwise indicated. A 9mg/mL stock solution was prepared in PBS. A series of working dilutionswere prepared in PBS to give concentrations of 90000, 9000, 6000, 3000,1000, 500, 200, 100, and 0 ng/mL. One microliter of each workingdilution was added to every 100 ul of plasma or serum followed byincubation at 37° C. for 1 hour. The final concentrations of Lp-PLA2inhibitor in plasma or serum were: 900, 90, 60, 30, 10, 5, 2, 1, and 0ng/mL.

Example 1 The Auto PAF AH Assay Kit

The Auto PAF AH assay kit, manufactured by Azwell (Osaka, Japan), iscommercially available in the United States through Karlan ResearchProducts Corporation (Santa Rosa, Calif.). This assay was evaluated onan Olympus Au640 clinical chemistry analyzer and is described in thisExample 1.

Materials

Azwell Auto PAF-AH Assay Kit:

R1: 200 mM HEPES, 200 mM NaCl, 5 mM EDTA, 10 mM CHAPS, 10 mM sodium1-nonanesulfonate, pH 7.6 R2A: 20 mM citric acid monohydrate, 10 mMsodium 1-nonanesulfonate, pH 4.5 R2B: 90 mM1-myristoyl-2-(4-nitrophenylsuccinyl) phosphatidylcholine

Assay Procedure

1. Enter assay parameters from the following table into the OlympusAu640 analyzer, and create a PAF AH assay program:

Sample volume: 2 μL

Reagent 1: 240 μL

Reagent 2: 80 μL

Wavelength (main): 410 nm

Wavelength (sub): 480 nm

Method: Rate

Point 1 (FST): 14

Point 1 (LST): 21

Calibration Type: MB Formula: Y=AX+B

Counts: 2

MB Type Factor: 11595

2. Prepare the following reagents:

R1: Use this buffer solution as supplied in Azwell Auto PAF AH assaykit. Store at 4° C. Protect from light.

R2: Prepare the R2 working solution by mixing R2A and R2B (supplied inAzwell Auto PAF AH assay kit) in the proportion of 19:1. Store at 4° C.Protect from light.

3. Aliquot 30 mL or more of each plasma sample into a 2 mL Sarstedtmicro-tubes (Sarstedt Incorporation, part No. 72.694.007). Brieflycentrifuge to spin down fibrin clots/particles in the plasma.

4. Place Sarstedt tubes containing plasma samples onto sample tubes thatfit the instrument. Run plasma samples through the Au640 analyzer. Afterchoosing the PAF AH assay program, the analytical procedure describedbelow is performed automatically:

Test sample (2 μL)+R1 (240 μL), 37° C., 5 minutes [0-5 minutes]

Add R2 (80 μL), 37° C., 5 minutes [5-10 minutes]

Measure the absorbance at 410 nm and 480 nm [6-8 minutes]

Calculate PAF AH activity (IU/L)

5. Include Bio-Rad Lyphochek Assayed Chemistry Control Level 1 and Level2 (C-310-5 and C-315-5, Bio-Rad, Hercules, Calif.) as quality controlsin each run. The Lp-PLA2 activity values for these two controls arewithin the range of normal human plasma Lp-PLA2.

Example 2 High Throughput Radiometric Assay for Measurement of Lp-PLA2Activity

A high throughput radiometric assay was developed for measuring Lp-PLA2activity in a sample. This assay is fully described in WO2005/001416. Asummary of a high throughput radiometric activity assay is provided inthis Example 2.

Equipment

Scintillation Counter TopCount Microplate Scintillation and LuminescenceCounter, Perkin-Elmer (formerly Packard), CA Centrifuge Allegra 25Rbenchtop centrifuge, Beckman Coulter, Calif. Plate shaker Lab-Line TiterPlate Shaker (VWR cat #57019-600) Oven Barnstead/Thermolyne, series9000, temperature range 10-250° C. (VWR cat#52205-065) 12-channelPipettors BRAND Transferpette®-12, BrandTech Scientific, Inc., Essex,Conn.

Material

Polypropylene Plates Costar* Brand 96-Well Plates, Polypropylene,Nonsterile, Without Lids, Costar 3365, Corning, Inc., Corning, N.Y. (VWRcat #29444-104) PicoPlate Plates 96-Well white solvent-resistantmicroplates, Perkin Elmer Life Sciences, Inc, Boston, Mass. (cat#6005162)

Reagents

HEPES (4-(2-hydroxyethyl)-1-piperazineethane sulfonic acid) SigmaChemical Co., St. Louis Mo. (Cat #H9897100)

Sodium Chloride, Sigma Chemical Co., St. Louis Mo. (Cat #S5150; 5.0 M)

EDTA, Sigma Chemical Co., St. Louis Mo. (Cat #E7889; 0.5 M)

³H-Platelet Activating Factor, 1-O-Hexadecyl-[acetyl-3H(N)],(3H-PAF)—NEN Life Science Products, Roxbury, Mass. (Cat #NET-910,supplied as an ethanol solution, typically 0.1 mCi/mL; 250 uCi)

C16-PAF, (1-hexadecyl-2-acetyl-sn-glycero-3-phosphocholine): AvantiPolar Lipids, Alabaster, Ala. (Cat #878110; 5.0 mg/ml)

MicroScint-20: Perkin Elmer Biosciences, Boston, Mass. (cat #6013621)

Fatty acid-free bovine serum albumin (BSA): Sigma Chemical Co., St.Louis Mo. (Cat # A0281; 1.0 gm)

Trichloroacetic acid (TCA): Sigma Chemical Co., St. Louis Mo. (Cat#T9159)

Assay Buffer

100 mM Hepes, pH 7.4

150 mM NaCl

5 mM EDTA

Store it at room temperature

Procedures

1. Prepare a ³H-PAF working solution (for 100 reactions):

a) Aliquot 480 μl ³H-PAF (10 μM=0.1 mCi/ml at 10.0 Ci/mmol) and 125.3 μlof [C16]PAF (5.0 mg/ml; MW: 524) to a tube;

b) Mix and air dry in the hood;

c) Resuspend the dried pellets in 12.0 ml of assay buffer giving workingsolutions of 100 μM PAF (i.e. ³H-PAF at 0.4 μM and cold [C16]PAF at 99.6μM);

2. Aliquot 5 μL of assay buffer (for Total counts and Blanks; n=8) orplasma samples in duplicates into a 96-well plate;

3. Equilibrate the plate to 21° C.;

4. Add 100 μl, of the ³H-PAF solution to each well, mix and incubate theplate at 21° C. for 5 minutes;

5. Add 50 μL of ice-cold BSA solution (50 mg/ml) to all wells, mix andincubate the plate in a refrigerator for 5 minutes;

6. Add 25 μL of ice-cold TCA solution (56%) to each well, mix andincubate the plate in a refrigerator for 15 minutes;

7. Centrifuge the plate at 6,000 g for 15 minutes at 4° C.;

8. Aliquot 45 μL of the supernatants to a 96-well polystyrene plate;

9. Add 10 μL of ³H-PAF working solution to 6 Total Counts wells;

10. Add 200 μL of MicroScint-20 scintillation cocktail to each well;

11. Cover the plate with a plate tape and vortex mix at max speed for 10minutes;

12. Get static off the plate by wiping with a wet tissue and drying withanother clean one;

13. Count with a TopCount scintillation counter for 2 minutes each; and

14. Calculate Lp-PLA2 activity:

Lp-PLA2activity(nmoles/min/ml)=160*(CPM_(45 μl-supe)−CPM_(Blanks))/(CPM_(10 μl-spiking)−CPM_(Blanks))

Where CPM_(45 μl-supe) is the average count from each sample

CPM_(Blanks) is the average count of the Blanks

CPM_(10 μl-spiking) is the average count of the Total Counts

Example 3

Correlation of Auto PAF AH Assay and High Throughput Radiometric Assay

A panel of 120 plasma samples from healthy human volunteers was assayedfor Lp-PLA2 activity at three clinics using the high-throughputradiometric assay described in Example 2. The same sample panel wasassayed using Azwell's Auto PAF AH assay described in Example 1 on theOlympus Au640 analyzer. Correlation was obtained against data generatedon the same panel of samples by the high throughput radiometric assay.Correlation coefficients (r) were 0.96, 0.94, and 0.95 for Auto PAF AHvs. the radiometric activity assay at the three clinics, respectively.The average CV between duplicates was 2.14% for the Auto PAF AH assay.

Example 4 Low Throughput Radiometric Assay

A low throughput radiometric assay capable of measuring Lp-PLA2 activityis provided below.

Materials

Scintillation Vials (Wheaton Omni Vials, Millville, N.J. (Cat #225402));Scintillation Fluid (EcoLite™, ICN, Costa Mesa, Calif. (Cat #882475))

Equipment

Beta Counter (Beckman Liquid Scintillation Counter, LS 5000TA, BeckmanInstruments, Fullerton, Calif.); Water Bath (Fisher Scientific, Edison,N.J. Microcentrifuge Jouan Inc., Winchester, Va., Model No. A-14)

Reagents

HEPES (4-(2-hydroxyethyl)-1-piperazineethane sulfonic acid)—SigmaChemical Co., St. Louis Mo. (Cat #H 9136)

Sodium Chloride—Sigma Chemical Co., St. Louis Mo. (Cat #S 7653)

Chloroform—Aldrich Chemical Co., Milwaukee, Wis. (Cat #36, 692-7)

Methanol—Aldrich Chemical Co., Milwaukee, Wis. (Cat #27, 047-4)

³H-Platelet Activating Factor, 1-O-Hexadecyl-[acetyl-³H(N)],(³H-PAF)-NEN Life Science Products, Roxbury, Mass. (Cat # NET-910,supplied as an ethanol solution, typically 0.1 mCi/mL)

C16-PAF, (1-hexadecyl-2-acetyl-sn-glycero-3-phosphocholine)—Avanti PolarLipids, Alabaster, Ala. (Cat #878110, supplied as 5 mg/mL CHCl₃solution)

Assay Buffer

HEPES/NaCl Buffer: 50 mM HEPES, 150 mM NaCl, pH 7.4 at 37° C.

Assay Solutions

³H-PAF working solution: Pipette 5 μCi (typically 50 μL of the solutionsupplied by the vendor) of H-PAF stock solution into a 1.4 mL glassvial. Add 340 ug (68 μL of a 5 mg/mL solution) of C16-PAF. Evaporate todryness under a gentle stream of nitrogen gas in a fume hood.Reconstitute with 1.3 mL of HEPES/NaCl buffer. This will preparesufficient working solution for approximately 62 assay tubes.

Assay Master Mix: In a 15 mL polypropylene tube, combine 7.3 mL ofHEPES/NaCl buffer and 1.1 mL of ³H PAF working solution. In the finalreaction mixture, after addition of the plasma sample, the finalconcentration of PAF (unlabelled C16-PAF+³H-PAF) is 50 uM (the 200 μLreaction volume contains 10 nmols PAF).

For testing the inhibition of LpPLA2 activity in plasma, the assay wasperformed as follows:

(1) 110 μL HEPES/NaCl buffer+20 μL of appropriate working dilution ofLp-PLA2 inhibitor+50 μL of plasma sample were added to a 1.5 mLmicrocentrifuge tube and incubated at 37° C. for 15 minutes.

(2) 20 μL of 3H-PAF working solution was added and the samples wereincubated at 37° C. for 30 seconds.

(3) Reactions terminated by the addition of 600 μL of CHCl₃/CH₃OH andprocessed by the assay procedures described herein.

Assay Procedures

1. Thaw plasma samples and place in 37° C. water bath to temperatureequilibrate.

2. Add 150 μL of assay master mix to 1.5 mL polypropylene tubes andplace in 37° C. water bath. Allow 5 minutes for temperatureequilibration.

3. Add 50 μL of plasma sample or 50 μL of HEPES/NaCl buffer for bufferblanks (all samples are assayed in duplicate) to appropriate tubescontaining assay master mix, vortex briefly, and incubate for 30 secondsin the 37° C. water bath.

4. Stop reaction by addition of 600 μL of CHCl₃/CH₃OH solution andvortex well.

5. Just prior to centrifuging, briefly re-vortex the samples. Separateorganic and aqueous phases by centrifugation in a microcentrifuge atmaximum speed for 2 minutes.

6. Collect 250 μL of the upper, aqueous phase and transfer to a new 1.5mL polypropylene tube.

7. Add 250 μL of CHCl₃ and vortex well.

8. Separate organic and aqueous phases by centrifugation in amicrocentrifuge at maximum speed for 1 minute.

9. Collect 150 μL of the upper, aqueous phase and transfer to a 7 mLscintillation vial.

10. Add 2 mL of EcoLite™ or equivalent liquid scintillation fluid.

11. Count samples in liquid scintillation counter using a countingprogram that has been set up to determine cpm, counting efficiency, anddpm.

12. For determination of total radioactivity in the reaction, duplicate150 μL aliquots of the assay master mix are counted.

Data Reduction and Analysis

Either cpm or dpm values may be used for calculation of Lp-PLA₂activity. If the counting efficiency is the same for the samples, bufferblanks, and total radioactivity vials, cpm values may be used. Ifdifferent counting efficiencies are observed, dpm values should be used.For all of the results in this report, dpm values were used for activitycalculations. The following equation is used to calculate LpPLA₂activity (reported as nmols/min/mL) from the raw data:

((x−y)/z)*40

where, x=cpm (or dpm) of plasma sample×1.65 (This corrects for the totalvolume of the aqueous phase in each extraction. This correction isnecessary since only a portion of the aqueous phase is collected aftereach of the extractions.) y=cpm (or dpm) of buffer blanks×1.65 (averageof duplicate determinations) z=cpm (or dpm) of total radioactivitysamples divided by 10 (there are 10 nmols of PAF in each reaction tube(average of duplicate determinations) 40=factor to adjust results tonmol/min/mL (each reaction is for 30 seconds and the volume of plasmaused in each reaction is 50 uL).

Example 5 Comparison of Inhibition of Lp-PLA2 Activity Measured by theAuto PAF AH Assay and Low Throughput Radiometric Assay

Plasma was collected from six human subjects at different timepointsafter in vivo drug administration of an Lp-PLA2 inhibitor during aclinical trial. Subjects #17 and #18 were dosed with 120 mg of FormulaI, described below and shown in FIG. 4A, subjects #24 and #25 with 180mg, and subjects #21 and #22 with 240 mg. Subjects #21 and #25 alsoreceived placebo on a different day. Lp-PLA2 activity was measured bythe low throughput radiometric assay, described in Example 4, and >90%inhibition was observed with all six drug-treated subjects. However,Lp-PLA2 inhibition was not apparent when measured by the Auto PAF AHassay, as described in Example 1. The Auto PAF AH assay is insensitiveto in vivo drug inhibition of Lp-PLA2. See FIG. 2 (Table 1) below.

Inter-run and within-run variability for the Auto PAF AH assay on theOlympus Au640 has been consistently low with CV less than 5% betweenreplicates. In this experiment, the average CV between duplicates was 2%for placebo samples and 3% for all drug samples. However, Lp-PLA2activity measured by the Auto PAF AH assay fluctuated over time for bothdrug and placebo subjects. Similarly, radiometric activity values forthe placebo subjects fluctuated over time with a higher % CV comparedwith the Auto PAF AH assay. See FIG. 3 (Table 2). Observed variabilityin Lp-PLA2 activity for the placebo subjects appears to be biologicalvariability.

Formula I, shown in FIG. 4A, is2-(2-(3,4-Difluorophenyl)ethyl)-1H-quinoline-4-1-ylN-(4′-trifluoromethylbiphenyl-4-ylmethyl)-acetamide bitartrate and isdescribed in WO 02/30904.

Example 6 Comparison of Inhibition of Lp-PLA2 Activity Measured by theAuto PAF AH Assay and Low Throughput Radiometric Assay

Plasma samples were evaluated from eight subjects who received 100 mg ofa second Lp-PLA2 inhibitor during a clinical trial. The Lp-PLA2inhibitor used in the study,1-(N-(2-(Diethylamino)ethyl)-N-(4-(4-trifluoromethylphenyl)benzyl)-aminoc-arbonylmethyl)-2-(4-fluorobenzyl)thio-5,6-trimethylenepyrimidin-4-onebitartrate, is shown in FIG. 4B and referred to as Formula II and isdescribed in WO 01/60805.

Four of the eight subjects also received placebo on a different day.

Greater than 90% inhibition of Lp-PLA2 activity was observed using thelow throughput radiometric assay for in vivo administration of theLp-PLA2 inhibitor. However, no inhibition was measured with the Auto PAFAH assay (see FIG. 5, showing Table 3). Lp-PLA2 activity valuesfluctuated for both the drug and placebo subjects as measured by AutoPAF AH assay apparently due to biological fluctuation.

Example 7 Substrate Specificity Testing

A manual colorimetric Lp-PLA2 activity assay was developed using thesubstrate 1-myristoyl-2-(p-nitrophenylsuccinyl) phosphatidylcholinemanufactured by Azwell (Osaka, Japan). This assay is a correspondingmicrotiter-plate version of the Auto PAF AH Assay compatible with aspectrophotometric plate reader. This manual assay was used to evaluatethe physical properties of the substrate. Presented here are data onsubstrate specificity.

Materials

R1: 200 mM HEPES, 200 mM NaCl, 5 mM EDTA, 10 mM CHAPS, 10 mM Sodium1-nonanesulfonate, pH 7.6, Store at 4° C.

R2A: 20 mM citric acid monohydrate, 10 mM sodium 1-nonanesulfonate, pH4.5,

R2B: 1-myristoyl-2-(4-nitrophenylsuccinyl) phosphatidylcholine, 90 mM

p-nitrophenol: Sigma-Aldrich Chemical Co., St. Louis, Mo. (Cat#1048-25G)

Ethanol: Sigma-Aldrich Chemical Co., St. Louis, Mo. (Cat #7023)

Methanol: VWR International, West Chester, Pa. (Cat # EM-MX0482-6)

Reagent Preparation

R2: Mix R2A and R2B in ratio of 10:1. Store at 4° C. for no longer thantwo weeks before use.

p-Nitrophenol standards: Make 1M of 4-nitrophenol solution in Methanol.Dilute 100 μL, 75 μL, 50 μL, 25 μL, 10 μL, 5 μL of the 1M solution in 1mL of Methanol to make 100, 75, 50, 25, 10, and 5 nmol/μL stock solutionrespectively. Make working solution for each standard by diluting 100 μLof stock solution into 900 μL of methanol (1:10 dilution). Store bothstock and working solution at 4° C.

Assay Procedure

1. Set temperature of the plate reader (SPECTRAmax® PLUS³⁸⁴UV/VISMicroplate Spectrophotometer, Molecular Devices, Sunnyvale, Calif.) at21° C.

2. Add 120 μL of R1 into each well in a 96-well flat-bottom assay plate(Costar 3595, Corning, Inc., Corning, N.Y.) using a multi-channelpipettor.

3. Add 10 μL of p-nitrophenol standard working solution into each of theduplicate wells in Column 1 and 2. Use 7 standard points for generatinga standard curve: 0, 5, 10, 25, 50, 75, 100 nmol/well. Leave well 1H and2H for blank controls.

4. Add 5 μL of plasma individually into each well. Use duplicate foreach sample. Set up blank controls by adding 5 μL of ddH₂O instead ofplasma into well 1H and 2H. Mix the plate well by hand.

5. Incubate the plate at 37° C. for 5 minutes.

6. Cool the plate at 21° C. in the plate reader for 5 minutes.

7. Take the plate out from the plate reader. Add 40 μL of R2 into eachwell using a multi-channel pipettor, changing tips after each addition.Time the start of R2 addition.

8. Add 2 μL of ethanol into each well using a multi-channel pipettor,changing tips after each addition. The purpose of this step is to rid ofall the air bubbles generated in wells. The duration between first R2addition and plate reading in Step #9 is 4 minutes.

9. Read the plate at 405 nm for 20 minutes with a 2-minute interval.Include a 2-minute auto-mixing before reading the plate.

Activity Calculation

1. Generate a standard curve by plotting average OD values at 0 and 20minutes (OD_(0min) and OD_(20min)) for the 7 standards vs. p-nitrophenol(nmol/well). Calculate the slope of the standard curve.

2. Calculate ΔOD values for each blank well between 2 and 4 minutes(OD_(4min)−OD_(2 min)) and average the two ΔOD values for the blanks

3. For each sample well, calculate ΔOD values between 2 and 4 minutesand then Lp-PLA2 activity (nmol/min/ml)=(ΔOD_(sample)−ΔOD_(blank))/slope(OD/nmol)/0.005 ml/2 minutes.

4. Calculate an average activity value for duplicate sample wells.

Results

Substrate specificity against Lp-PLA2 was assayed by using two Lp-PLA2inhibitor compounds; Formula II, which is described in Example 6, andFormula III, which is shown in FIG. 4C. Formula III is1-(N-(2-(Diethylamino)ethyl)-N-(4-(4-trifluoromethylphenyl)benzyl)aminoca-rbonylmethyl)-2-(4-fluorobenzyl)thio-5-(1-methylpyrazol-4-ylmethyl)pyrimid-in-4-oneis described in WO 00/66567.

Plasma samples from four healthy patients were incubated in vitro withincreasing amount of Formula III. For addition of the inhibitor solutionto the reaction mixtures, a 100 mM stock solution was prepared in DMSO.A series of 1:10 working dilutions were prepared in DMSO to giveconcentrations which ranged between 10 mM and 0.01 nM. One microliteraliquots of each working dilution were added in each reaction. The finalconcentrations of Lp-PLA2 inhibitor were (in nM) 60,000, 6,000, 600, 60,6, 0.6, 0.06, 0.006, 0.0006, 0.00006 and 0.

All four plasma demonstrated decreasing Lp-PLA2 activity as shown inTable 4 (FIG. 6). Inhibition achieved by Formula III in all four samplesreached over 90%, comparable to the natural Lp-PLA2 substrate PAF usedin the radiometric activity assay. Formula II also showed over 90%inhibition of the substrate hydrolysis when incubated in vitro in thesame four plasma samples.

The assay buffer used in above experiments has high content of detergent(7.5 mM CHAPS and 10 mM Sodium 1-nonanesulfonate). When detergent waseliminated from the assay, Formula III only inhibited about 65% ofhydrolysis activity in plasma sample #10. When detergent was added inthe parallel experiment inhibition of more than 95% was reached.Therefore, it appears that this substrate is specific to Lp-PLA2 onlywhen it is assayed in the presence of buffer comprising detergent, asshown in Table 5 (FIG. 7).

Example 8 Modified Drug Sensitive Colorimetric Assay for Measurement ofLp-PLA2 Activity

For the Auto PAF AH assay, plasma samples are diluted about 160-fold andthe substrate is used at a concentration higher than its Km. It appearsthat when the concentration of substrate is higher than its Km thesubstrate competes with drug bound to Lp-PLA2 and promotes drugdissociation from the enzyme. For instance, the substrate concentrationused in the Auto PAF AH assay is 1100 μM, which is more than 5 timeshigher than its Km (Km is about 200 μM when plasma is used as the enzymesource and assayed by Auto PAF AH protocol, see Example 1).Pre-incubation of plasma with buffer R1 in Auto PAF AH assay alsoappears to promote drug dissociation before the start of assay reaction.Therefore, the assay of the present invention was modified by usinghigher plasma sample volumes and lower substrate concentrations comparedwith the Auto PAF AH assay. Additionally, the pre-incubation step ofplasma with R1 prior to substrate addition was eliminated. Moreover,elimination of buffer R2A increased reaction rates, which in turnenabled the use of lower substrate concentrations and a shorter assayincubation time during which drug dissociates compared with the Auto PAFAH assay

Materials

R1: 200 mM HEPES, 200 mM NaCl, 5 mM EDTA, 10 mM CHAPS, 10 mM sodium1-nonanesulfonate, pH 7.6

R2B: 90 mM 1-myristoyl-2-(4-nitrophenylsuccinyl) phosphatidylcholine

p-nitrophenol: Sigma-Aldrich Chemical Co., St. Louis, Mo. (Cat#1048-25G)

Reagent Preparation

Assay buffer: Mix R2B and R1 in a ratio of 0.66 μl, to 110 μL. Store onice or at 4° C. Prepare immediately before use.

p-Nitrophenol standards: Prepare 1M p-nitrophenol in methanol. Dilute100, 75, 50, 25, 10 and 5 μL of 1M p-nitrophenol to 1 mL in methanol toprepare 100, 75, 50, 25, 10 and 5 nmol/μL stock solutions, respectively.Prepare working solutions for each standard by diluting 40 μL of stocksolution into 960 μL of methanol (1:25 dilution). Store stock andworking solutions at 4° C.

Assay Procedure

1. Add 120 μL of assay buffer to each well in a 96-well V-bottom plate(Costar 3897, Corning, Inc., Corning, N.Y.) using a multi-channelpipettor or robot.

2. Add 25 μL of p-nitrophenol standard working solution into duplicatewells in columns 1 and 2 on another 96-well flat-bottom plate (Costar9017, Corning, Inc., Corning, N.Y.). Use 7 standard points forgenerating a standard curve: 0, 5, 10, 25, 50, 75, 100 nmol/well. Add 25μL of PBS into well 1H and 2H for blank controls.

3. Briefly centrifuge plasma to spin down fibrin clot/particles. Add 25μL of plasma per well in columns 3-12 on the same flat-bottom platecontaining p-nitrophenol standards. Use duplicates for each sample

4. Use a multi-channel pipettor or a robot to transfer 110 μL of assaybuffer from the V-bottom plate to the flat-bottom assay plate containingplasma samples and p-nitrophenol standards. A Zymark RapidPlate (CaliperLife Sciences, Hopkinton, Mass.) can perform this step withoutgenerating bubbles in the wells. Other transfer methods may generatebubbles due to the high detergent content of R1. A small volume ofethanol can be used to eliminate air bubbles.

5. Immediately place the assay plate onto the plate reader (SPECTRAmax®PLUS³⁸⁴UV/VIS Microplate Spectrophotometer, Molecular Devices, SunnyvaleCalif.) and auto-mix for 15 seconds.

6. Read the plate at 405 nm for 10 minutes at 15-second intervals atroom temperature. The duration between the start of enzymatic reaction(addition of assay buffer to the assay plate) and completion of thefirst absorbance reading is 1 minute.

The assay may be performed at room temperature. More stringenttemperature control may be required if room temperature fluctuateswithin or between labs.

Activity Calculation

1. Generate a standard curve by plotting average OD values at 0 and 10minutes (OD_(0min) and OD_(10min)) for the seven standards vs.p-nitrophenol (nmol/well). Calculate the slope of the standard curve.

2. Calculate Change in (SOD) values for each blank well between 1 and 3minutes (OD_(3min)−OD_(imm)) and average the two SOD values for theblanks

3. For each sample well, calculate ΔOD values between 1 and 3 minutesand then Lp-PLA2 activity (nmol/min/ml)=(ΔOD_(sample)−ΔOD_(blank))/slope(OD/nmol)/0.025 ml/2 minutes.

4. Calculate an average activity value for duplicate sample wells.

Example 9 Comparison of Radiometric Measurement Versus Modified DrugSensitive Colorimetric Measurement of Lp-PLA2 Activity in the Presenceof Lp-PLA2 Inhibitor

Lp-PLA2 activity from blood plasma samples obtained from a healthy humansubject administered an Lp-PLA2 inhibitor was measured using the highthroughput radiometric assay described in Example 2 and the methods ofExample 8 with the following minor changes. The volume of plasma usedper well was 25 μL. Substrate concentration was 1125 μM and, 2 μL ofsubstrate solution R2B was mixed in 40 μL of R2A before further mixingwith 95 μL of R1 to make the assay buffer. Blood plasma samples werecollected at five timepoints after dosing (0.5, 1.0, 6.0, 48 and 96hours post dosing). Both radiometric and colorimetric assays were usedto determine Lp-PLA2 activity as well as percent inhibition in eachsample as shown in Table 6. As shown in Table 6 (FIG. 8), percentinhibition of Lp-PLA2 activity as measured by a radiometric assay showedpeak inhibition as about 94% one hour after dosing while a modified drugsensitive colorimetric assay showed peak inhibition at the 6-hourtimepoint with about 64% inhibition in activity. These data demonstratethat both methods can be used to measure the inhibition of Lp-PLA2activity in samples obtained from an animal that has been administeredan Lp-PLA2 inhibitor. Blood samples from humans are considered to beessentially free of Lp-PLA2 inhibitor 96 hours post dosing.

Example 10 Testing of Plasma Samples from a Clinical Study for Lp-PLA2Inhibition

Four human subjects recruited in a clinical trial of a novel Lp-PLA2inhibitor, Formula I (see Example 5) received different doses of thedrug. Drug dose for Subject #13, #36, #24, and #41 was 80 mg, 120 mg,180 mg, and 240 mg, respectively. Plasma was collected at 0, 0.5, 1, and3 hours after drug administration. Lp-PLA2 activity of these plasmasamples was assayed by the low throughput radiometric assay described inExample 4, the Auto PAF AH assay, described in Example 1, and modifieddrug-sensitive colorimetric assay, which is described in this Example 8.While the radiometric activity assay indicated >90% inhibition ofLp-PLA2 activity 3 hours after dosing in all four subjects, the Auto PAFAH assay failed to indicate drug inhibition. However, a modifieddrug-sensitive colorimetric assay of Example 8 indicated 85-90% druginhibition as shown in Table 7 (FIG. 9).

Similarly, both the radiometric assay and modified drug-sensitivecolorimetric assay showed a measured time-dependent effect on Lp-PLA2activity after dosing with Lp-PLA2 inhibitor as shown in Table 8 (FIG.10). Little effect on Lp-PLA2 activity was observed using the Auto PAFAH assay as shown in Table 8 (FIG. 10).

Although the activity values generated from radiometric and modifieddrug-sensitive colorimetric assay are different, correlation between thetwo assays is r=0.975 for these 16 clinical plasma samples. Therefore,modified drug-sensitive colorimetric assays, described herein, althoughusing the same substrate as the Auto PAF AH assay, demonstrated abilityto detect in vivo drug inhibition of Lp-PLA2 in drug-treated humansubjects, while the Auto PAF AH assay did not.

Example 11 Testing of Additional Plasma Samples from a Clinical Studyfor Lp-PLA2 Inhibition

Plasma samples were collected from ten subjects in a clinical trial forthe Lp-PLA2 inhibitor of Formula I. Subjects #109, #114, #115, #142 and#145 received 50 mg of Formula I while subjects #118, #119, #121, #123and #124 received 120 mg of the compound. Lp-PLA2 activity of theseplasma samples were assayed by the high throughput radiometric assay asdescribed in Example 4, the Auto PAF AH assay as described in Example 1,and modified drug-sensitive colorimetric assay as described in Example8. Consistently, the Auto PAF AH assay failed to measure drug inhibitionof Lp-PLA2 activity in these samples with maximal inhibition of 29%detected in subject #123. However, a modified drug-sensitivecolorimetric assay of Example 8 indicated comparable drug inhibitionwith radiometric assay in all subjects. Inhibition values for theradiometric assay and a modified, drug-sensitive colorimetric assayagreed within 15% for all but four time (#114/12 hr, #115/12 hr,#142/0.5 hr and #142/12 hr) as shown in Table 9 (FIGS. 11 part 1, 11part 2 and 11 part 3).

Correlation of r=0.95 was obtained between a modified, drug-sensitivecolorimetric assay and the radiometric assay for the 100 samplesanalyzed in this study. The Auto PAF AH assay showed poor correlationwith radiometric assay in these drug dosed samples (r=0.31).

Example 12 Assay Dynamic Range Instrument Low Limit of Quantitation

Twenty-five microliters of PBS were added into 110 μL of R1 containing0.67 μL of R2B. Sixteen replicates were prepared and randomly placed inwells across a microtiter plate. Absorbance at 405 nm was obtained andstandard deviation calculated between replicates. Six times standarddeviation (6*SD) was defined as the lower limit of quantitation for themicrotiter plate reader (SPECTRAmax® PLUS³⁸⁴UV/VIS MicroplateSpectrophotometer, Molecular Devices, Sunnyvale, Calif.). The average ODreading from 16 replicates was 0.0437 with a standard deviation of0.0009. The lower limit of quantitation for the microtiter plate readerwas defined as 6*0.0009 or a change of 0.0054 OD units during assayincubation.

Linear Detection Range of p-Nitrophenol

Serial dilutions of p-nitrophenol were prepared in methanol. Twenty-fivemicroliters of p-nitrophenol at each concentration were added to 110 μlR1 (without R2B) in a microtiter plate. Absorbance values at 405 nm werelinear between 0.05 to 125 nmol of p-nitrophenol (r=0.996). However, theblank corrected absorbance of the 0.05 nmol p-nitrophenol sample wasonly 0.00415, which is below the microtiter plate reader's lower limitof quantitation of 0.0054 OD as defined above. Therefore, the lineardetection range of p-nitrophenol is set between 0.1 and 125 nmol ofp-nitrophenol per well.

Assay Dynamic Range

Assay dynamic range was defined by using both recombinant human Lp-PLA2protein (hrLp-PLA2) generated in-house and Lp-PLA2 protein purified fromhuman plasma in-house.

hrLp-PLA2 was serially diluted and 25 μL of each diluted hrLp-PLA2 wereassayed by a modified drug-sensitive colorimetric assay (data shown inFIG. 12, Table 10). The second least amount of hrLp-PLA2 assayed 206ng/mL showed an activity of 1.5 nmol/min/mL. Such level of activitywould only generate 0.075 nmol of p-nitrophenol in two minutes ofsubstrate hydrolysis reaction in the current assay configuration.Therefore, it is lower than the linear detection range of the endproduct p-nitrophenol. hrLp-PLA2 greater than 13200 ng/mL showed plateauactivity. The activity of hrLp-PLA2 between 412 to 13200 ng/mLdemonstrated linearity with an R value of 0.997. Therefore, the dynamicrange of this assay appears to be between 4.4 and 397 nmol/min/mL,although lower and upper limits could be further defined. (see FIG. 12,Table 10).

hLp-PLA2 purified from plasma was also serially diluted and 25 μL ofeach dilution were assayed by a modified drug-sensitive colorimetricassay (data shown in Table 11). The activity of purified hLp-PLA2protein ranged between 6.25 to 1200 ng/mL demonstrated linearity with anR value of 0.97. Therefore, the dynamic range assessed using purifiedhLp-PLA2 appears to be between 2.47 and 363.60 nmol/min/mL, comparableto the one defined by hrLp-PLA2 (see FIG. 13, Table 11). The relativelylower upper limit of the dynamic range determined by purified hLp-PLA2may be resulted from interference factors possibly present in thepurified product and/or introduced during purification process. Limitedavailability of such purified protein prevents further investigation.

Example 13 Substrate Stability

Stability of the substrate in modified assay buffer (110 μL R1+0.67 μLR2B+25 μL PBS) was examined by monitoring absorbance changes every 15minutes over 120 minutes at room temperature. Although absorbanceincreased slowly but consistently over 2 hours reflecting gradualsubstrate degradation, the change in absorbance was only 0.002 OD unitsper 15 minutes. Therefore, substrate degradation appears to be moderateover 2 hours under a modified assay conditions. Since the assay takesonly 10 minutes to complete and activity is calculated based on a2-minute reaction period, absorbance changes from substrate degradationare insignificant and can be blank-corrected.

Example 14 Effect of Pre-Incubation of Human Plasma with Buffer R1 onDrug-Sensitivity

In the Auto PAF AH assay, plasma is pre-incubated in buffer R1 at 37° C.for 5 minutes. This pre-incubation step may accelerate the dissociationof drug bound to Lp-PLA2 before the start of the reaction. To testwhether accelerated dissociation occurs, a plasma sample from a humansubject (#10) was incubated with increasing amount of Lp-PLA2 inhibitorat 37° C. for an hour. Twenty-five microliters of the in vitro FormularII drug-treated plasma was then pre-incubated with 100 μL R1 at roomtemperature for different times before running the assay for 10 minutesat room temperature after addition of 40 uμL of R2 (final substrateconcentration of 1100 μM). Pre-incubation of plasma with R1 decreaseddrug-inhibition especially at lower drug concentrations. The highestlevel of drug inhibition was obtained when R1 and R2 were premixed andadded directly to plasma without pre-incubation, as shown in Table 12(FIG. 14). Pre-incubation of plasma in R1 at 37° C. instead of roomtemperature further deteriorates drug inhibition.

Example 15 Effect of Substrate Concentration on Drug-Sensitivity

The substrate concentration is 1100 μM in the Auto PAF AH assay, whichis more than 5 times higher than its Km (Km=200 μM when plasma is usedas the enzyme source and assayed by Auto PAF AH protocol). Highsubstrate concentrations may compete with drug binding to Lp-PLA2. Totest this possibility, 25 μL of in vitro Lp-PLA2 inhibitor Formular IItreated human plasma samples were added to premixed R1 (100 μL) and R2(40 μL) containing different amounts of the substrate. Substratehydrolysis was immediately monitored at room temperature for 10 minutes.Lower substrate concentrations indicate greater drug inhibition.Activity values approached the lower limit of quantitation at the higherdrug levels when the substrate was used at 154 μM or less due to slowerhydrolysis rates. Consequently, the substrate concentration should bemaintained slightly above its Km in order to drive rapid substratehydrolysis while maintaining drug inhibition levels, as shown in Table13 (FIG. 15).

Example 16 Effect of Human Plasma Sample Volume on Drug-Sensitivity

Two μL of plasma were assayed in a 320 μL reaction for the Auto PAF AHassay, which corresponds to a plasma dilution factor of 160-fold. Highplasma dilution may promote drug dissociation from Lp-PLA2.Consequently, 5 to 50 μL of an in vitro Lp-PLA2 inhibitor Formula IItreated plasma sample were diluted with varying volumes of R1 and 40 μLof R2 to a final volume of 165 μL containing 1100 μM substrate.Hydrolysis was immediately monitored at room temperature for 10 minutes.Greater drug inhibition was observed with higher plasma sample volumes,as shown in Table 14 (FIG. 16).

Example 17 Effect of Deletion of Buffer 2A on Drug-Sensitivity

In the Auto PAF AH assay, the substrate stock solution R2B is premixedin buffer R2A (20 mM citric acid monohydrate, 10 mM sodium1-nonanesulfonate, pH 4.5), which acts as a substrate stabilizer. Thesubstrate, after diluted in R2A, remains stable at 4° C. for 14 days.Faster hydrolysis rate was observed when R2A was omitted from the assay.For example, a colorimetric assay was performed with nmol of substrate(2 μL of R2B) and either 25 μL or 50 μL of plasma. Additionally, samplescontained either 0 μL or 40 μL of R2A. All reactions were diluted toeither 125 μl or 165 μL with R1. Buffer components were pre-mixed andthe reaction was initiated upon human plasma addition. Substratehydrolysis was immediately monitored at room temperature for 10 minutes.Vmax (milliOD/min) was calculated and compared among differentconditions. Higher hydrolysis rates were observed upon omission of R2A,independent of plasma volume as shown in Table 15 (FIG. 17).

Since R2A has low pH of 4.5 compared with the other assay buffercomponents, whether addition of R2A affected the pH of the assayreaction was determined. The pH of assay reactions containing 110 μL ofR1, 0.66 μL of R2B and 25 μL of either plasma or ddH₂O were 7.52 and7.53, respectively. The pH dropped to 7.43 and 7.42, respectively, when40 μL of R2A were added to these assay samples. The effect of R2A onLp-PLA2 hydrolysis rates of the substrate is probably more thanpH-related.

Elimination of R2A from the assay increased hydrolysis rates, therebyallowing the use of lower substrate concentrations and shorter assayincubation times, both of which lower drug dissociation. Lp-PLA2activity values approached the lower limit of quantitation when 25 μL ofplasma were measured using 154 μM of substrate and R2A as described inExample 14. A substrate titration experiment was repeated using 50 μL ofin vitro Formula II-treated plasma (subject #10) and 75 μL of assaybuffer containing only R1 and R2B (no R2A). Assays were monitored atroom temperature for 10 minutes at 405 nm and Vmax and drug inhibitionwere calculated. Hydrolysis activity exceeded the lower limit ofquantitation at 900 and 9000 ng/mL of drug even at substrateconcentrations as low as 65 μM (see FIG. 18, Table 16). Consequently,R2A was eliminated and lower substrate concentrations were incorporatedin a modified colorimetric activity assay.

Earlier studies indicated higher drug inhibition as the substrateconcentration was lowered over 2200 μM to 273 μM in combination with 25uL of human plasma. However, no significant effect on drug inhibitionwas observed when substrate concentration was lowered over 273 μM to 65μM using 50 μL of plasma, which suggests drug dissociation is notpromoted by lower substrate levels with higher plasma volumes over thisrange.

Example 18 Design of Experiment Software

After identifying individual factors that contribute to the druginsensitivity of the original Auto PAF AH assay, JMP software (Design ofExperiment, herein “DOE”) was used to design experiments investigatinginteractions between individual factors and to identify optimalcombinations for detecting drug inhibition over an adequate dynamicrange.

DOE Experiment #1

The first DOE experiment focused on four factors including buffer R1volume (2 levels), plasma volume (4 levels), substrate concentration (8levels) and drug treatment (2 levels). The indicated levels of substrateconcentration refer to the substrate concentration in the aliquot ofpremixed R2B/R1 added to each reaction unless otherwise noted. Althougha full factorial combination of variables would require 128 assayreactions, D-optimal design suggested 48 different combinations. These48 reactions were performed in duplicate, using a single plasma samplewith or without prior in vitro incubation with Formula II at 37° C. foran hour. Substrate was directly diluted into R1 and plasma was thenadded to start hydrolysis at room temperature. Vmax and drug inhibitionwere calculated based on absorbance readings at 405 nm over 5 minutes atroom temperature.

JMP predicted that a combination of 15 μL or 25 μL of plasma and 110 μLof R1 containing 273 μM to 1100 μM substrate would indicate 90% orgreater drug inhibition. This set of conditions would also yieldreasonably high Vmax so that heavily drug-treated plasma would not fallbelow the lower limit of quantitation. The lowest substrateconcentration included in this experiment, 65 μM in 110 μL of R1, waspredicted to detect 93.41% drug inhibition when used with 25 μL ofplasma (final substrate concentration of 53 uM). However, Vmaxprediction was as low as 16.79 for the non-drug-treated sample. Suchcondition, although did not proceed for further optimization, could beused to assay specific sample sets that have low and narrow range ofLp-PLA2 activity.

DOE Experiment #2

The second DOE experiment focused on the conditions identified by theprior DOE experiment. It designed a full factorial combination of allvariables including R1 volume (1 level), plasma volume (2 levels),substrate concentration (4 levels) and drug treatment (4 levels).Thirty-two conditions were assayed in duplicate. The assay protocol wasidentical to the first DOE experiment. The indicated levels of substrateconcentration again refer to the substrate concentration in the aliquotof premixed R2B/R1 added to each reaction unless otherwise noted.Prediction Profiler predicted that 25 μL plasma and 110 μL of R1containing 545 μM substrate would generate a Vmax of 76 milliOD/min fornon-drug treated plasma and indicate close to 95% drug inhibition forplasma treated with 900 ng/mL of drug in vitro. Therefore, a modified,drug-sensitive assay uses 25 μL of plasma with 110 μL of R1 containing545 μM substrate for a final substrate concentration of 440 μM in theassay.

An alternative set of conditions was also identified (15 μL of plasmaand 110 μL of R1 containing 545 μM for a final substrate concentrationof 475 μM in the assay) that indicated 94% drug inhibition and Vmax=53milliOD/min for non-drug-treated plasma.

Example 19 Reaction Time

Four human plasma timepoint samples from a single subject, who wastreated in vivo with Lp-PLA2 inhibitor drug, were assayed for Lp-PLA2activity by a modified, drug-sensitive colorimetric assay containing 440μM substrate and 25 μL of plasma (described in Example 8). The same fourplasma samples were also assayed by the same assay protocol but with 50μL of plasma and 154 μM of substrate (see FIG. 19, Table 17). The first5 minutes of hydrolysis were monitored for each reaction and five Vmaxvalues were calculated based on time intervals of 1, 2, 3, 4 or 5minutes from the start of the reaction. Samples corresponding to highLp-PLA2 inhibition (1 and 3 hour post-dose) exhibited higher Vmax valuesfor longer assay reaction times when 25 mL plasma and 440 μM substratewere used. This suggests drug dissociation may occur under suchcondition where competition between drug and substrate is relativelystrong. In contrast, Vmax values for 1 and 3 hour post-dose time pointswere independent of assay reaction time when more plasma and lowersubstrate was used (e.g., 50 μL plasma/154 M substrate). However, Vmaxvalues tend to decrease with longer assay reaction times for sampleswith lower drug inhibition (0 and 0.5 hours) especially at higher plasmavolume and lower substrate concentration as appreciable total substrateis consumed with high Lp-PLA2 activity. Therefore, assay performance isaffected by at least three factors affecting three attributes: (1) Highplasma volume, short incubation time and low substrate concentrationpromote measurement of high levels of drug inhibition; (2) Low plasmavolume, short incubation time and high substrate concentration promote ahigh upper limit of quantitation; (3) High plasma volume, longincubation time and high substrate concentration promote sensitive lowerlimits of quantitation.

The implementation of robotics is recommended to shorten the timebetween addition of substrate into plasma and the first absorbancereading on the plate reader. Current protocol assembles and mixes anentire microtiter plate of reactions and start plate reading 1 minuteafter starting the first reaction on the plate. Activity calculationsare based on data collected at 1 and 3 minutes in the microtiter platereader. However, since absorbance readings are collected for 10 minutesat 15-second intervals, depending on the objective of the assay andrange of activity seen with a specific sample set, shorter and/orearlier, or longer reaction time could be chosen to calculate Lp-PLA2activity.

Example 20 Further Assay Testing Inter-Assay Validation

Intra-assay variability was assessed using plasma samples from 10healthy (non-fasted) human subjects. Six replicates of plasma from eachsubject were assayed on the same assay plate. The CV for individualsubjects ranged from 2.57 to 9.14% with an average intra-assay CV of5.36% as shown in Table 18 (FIG. 20).

Inter-Assay Variability

Inter-assay variability was assessed using plasma samples from 10healthy human subjects (non-fasted), assayed in three separate assays ondifferent days. The inter-assay CV for individual plasma samples rangedfrom 1.90 to 23.78% with an average inter-assay CV of 7.59%. Plasma fromSubject #5181480 (inter-assay CV=23.78%) had a white/turbid appearanceafter brief centrifugation, suggesting high lipid content in the sampleas shown in Table 19 (FIG. 21).

Inter-Operator Variability

Inter-operator variability was assessed using plasma samples from 10healthy subjects assayed by three different operators on different days.The inter-operator CV for individual plasma samples ranged from 5.11 to14.91% with an average inter-operator CV of 8.32% as shown in Table 20(FIG. 22).

Freeze/Thaw Effect

Plasma samples are normally received and stored frozen. In the case ofrepeat analysis, samples are commonly subject to freeze/thaw cycles. Tenplasma samples were analyzed after each of four freeze/thaw cycles. Nodefinitive trend in Lp-PLA2 values was observed, indicating samples maybe frozen and thawed four times, as shown in Table 20 (FIG. 22).

Example 21 Higher Drug Inhibition and Assay Dynamic Range

Four hundred forty microMolar (440 μM) substrate and 25 μL, of plasmasample volume were selected for use in the current modified assayprotocol since they offered high detectable in vivo drug inhibitionwhile maintaining adequate assay dynamic range. However, furtherlowering substrate concentration and/or increasing plasma sample volumein the assay could detect higher measurable drug inhibition in vivo atexpense of assay dynamic range. Plasma samples from 5 human subjectsreceiving Formula II for 9 days in a clinical study were collected onday 10 at different time points. Pre-dose plasma samples for eachsubject on day 0 of the study were also available. When 440 μM substrateand 25 μL of plasma were used in the assay, maximal 68% drug inhibitionwas observed in Subject N030 at 4 hour-timepoint as shown in Table 22(FIG. 24). Lowering substrate concentration to 112 μM while maintaining25 μL of plasma volume increased drug inhibition to 76% at this timepoint. Further increase in drug inhibition to 79% at 4 hour-timepoint,was achieved with both lower substrate concentration of 112 μM andhigher plasma volume of 45

Plasma samples from the other four subjects were analyzed using both 440μM substrate/25 μL plasma and 112 μM substrate/45 μL plasma assaycondition. The maximal drug inhibition detected with 440 μM substrateand 25 μL plasma was between 68% and 80% in these subjects as shown inTable 23 (FIG. 25). However, the use of 112 μM substrate and 45 μL ofplasma further improved measurable drug inhibition in the same subjectswith maximal inhibition between 87% and 98%. With 112 μM substrate/45 μLplasma, the absolute Lp-PLA2 activity value decreased significantly withthose at highest drug inhibition points approaching lower limit ofp-nitrophenol linear detection range described in Example 12. Forexample, the 4 hour-timepoint plasma for Subject N028 showed Lp-PLAactivity of 1.31 nmol/min/mL (see Table 23). Such level of activitywould only generate 0.12 nmol of p-nitrophenol in two minutes of assaytime based on a modified drug sensitive colorimetric assay described inExample 8, slightly above the low end of p-nitrophenol linear detectionrange 0.1 nmol.

To define the assay dynamic range for using 112 μM of substrate and 45μL of plasma, serially diluted recombinant human Lp-PLA2 protein wasassayed for Lp-PLA2 activity. The activity of hrLp-PLA2 between 4.88 to312.50 ng/mL demonstrated linearity with an R value of 0.96 (see FIG.26, Table 24). Therefore, the dynamic range appears to be between 2.71and 84.14 nmol/min/mL. Compared to the dynamic range between 4.4 and 397nmol/min/mL for 440 μM of substrate and 25 μL of plasma determined inExample 12 using hrLp-PLA, 112 μM substrate/45 μL plasma, althoughlowering low limit of quantitation, could only offer limited assayrange. Therefore, such conditions with lower substrate concentration andhigher sample volume could be used when higher measurable in vivoinhibition is desired while the range of Lp-PLA2 activity for testsamples is limited or could be compromised. One example such conditionscould be applied to is in clinical studies for Lp-PLA2 inhibitor drugsin which most post-drug test samples demonstrate low Lp-PLA2 activityresulted from drug inhibition. Earlier and shorter reaction time couldbe considered to use in activity calculation to improve assay dynamicrange when such conditions are used.

The assay dynamic range of 2.71-84.14 nmol/min/mL determined byhrLp-PLA2 was calculated based on absorbance change between 3 minutesand 1 minute after the start of reaction. When absorbance differencesbetween 1 minute and 0 minutes of the reaction were used to calculateLp-PLA2 activity from the same data, dynamic range was significantlyimproved to 3.2-196.5 nmol/min/mL (see FIG. 27, Table 25). Shorteningreaction time to 30 seconds in activity calculation showed littlefurther improvement.

Example 22 Detection of Lp-PLA2 Activity and its In Vitro DrugInhibition in Serum

To assess the utility of a modified calorimetric assay for measuringLp-PLA2 activity and particularly its drug inhibition in serum, 10 serumsamples collected from normal donors were assayed. The measured Lp-PLA2activity shown in FIG. 28 (Table 26) ranged between 130 and 190nmol/min/mL for these serum samples. The % CV between duplicates of eachsample was mostly less than 5%. No matched plasma samples were availablefor analysis. However, pre-dose plasma samples from 14 subjectsdescribed in Example 10 and 11 showed a comparable range of Lp-PLA2activity between 80 and 200 nmol/min/mL.

Since no serum samples were available from human subjects administeredLp-PLA2 inhibitors, 2 serum samples, BRH28861 and BRH28867, werepre-treated in vitro with different doses of Lp-PLA2 inhibitor FormulaII. The dose range used in vitro contained the range of in vivo plasmaconcentrations of such inhibitor in human subjects receiving drug duringclinical studies of Formula II. Based on pharmacokinetics data, 90 ng/mLrepresented the peak plasma level of Formula II when administered invivo. These in vitro drug-treated serum samples were then assayed forLp-PLA2 activity by a modified colorimetric assay. FIG. 29 (Table 27)shows that BRH28861 and BRH28867 reached 88.25% and 90.77% inhibition ofLp-PLA2 activity, respectively, when treated with 90 ng/mL of Formula IIin vitro. Higher drug dose at 900 ng/mL level further increased druginhibition to 97.71% and 92.28% respectively in these two serum samples.

All publications and references, including but not limited to patentsand patent applications, cited in this specification are hereinincorporated by reference in their entirety as if each individualpublication or reference were specifically and individually indicated tobe incorporated by reference herein as being fully set forth. Any patentapplication to which this application claims priority is alsoincorporated by reference herein in its entirety in the manner describedabove for publications and references.

Terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention.For example, as used herein, the singular forms “a”, “an” and “the” areintended to include the plural forms as well, unless the context clearlyindicates otherwise. It will be further understood that the terms“comprises” and/or “comprising,” when used in this specification,specify the presence of stated features, steps, operations, elements,and/or components, but do not preclude the presence or addition of oneor more other features, steps, operations, elements, components, and/orgroups thereof. As used herein, the term “and/or” includes any and allcombinations of one or more of the associated listed items and may beabbreviated as “/”.

Although the terms “first” and “second” may be used herein to describevarious features/elements (including steps), these features/elementsshould not be limited by these terms, unless the context indicatesotherwise. These terms may be used to distinguish one feature/elementfrom another feature/element. Thus, a first feature/element discussedbelow could be termed a second feature/element, and similarly, a secondfeature/element discussed below could be termed a first feature/elementwithout departing from the teachings of the present invention.

As used herein in the specification and claims, including as used in theexamples and unless otherwise expressly specified, all numbers may beread as if prefaced by the word “about” or “approximately,” even if theterm does not expressly appear. The phrase “about” or “approximately”may be used when describing magnitude and/or position to indicate thatthe value and/or position described is within a reasonable expectedrange of values and/or positions. For example, a numeric value may havea value that is +/−0.1% of the stated value (or range of values), +/−1%of the stated value (or range of values), +/−2% of the stated value (orrange of values), +/−5% of the stated value (or range of values), +/−10%of the stated value (or range of values), etc. Any numerical rangerecited herein is intended to include all sub-ranges subsumed therein.

Although various illustrative embodiments are described above, any of anumber of changes may be made to various embodiments without departingfrom the scope of the invention as described by the claims. For example,the order in which various described method steps are performed mayoften be changed in alternative embodiments, and in other alternativeembodiments one or more method steps may be skipped altogether. Optionalfeatures of various device and system embodiments may be included insome embodiments and not in others. Therefore, the foregoing descriptionis provided primarily for exemplary purposes and should not beinterpreted to limit the scope of the invention as it is set forth inthe claims.

The examples and illustrations included herein show, by way ofillustration and not of limitation, specific embodiments in which thesubject matter may be practiced. As mentioned, other embodiments may beutilized and derived there from, such that structural and logicalsubstitutions and changes may be made without departing from the scopeof this disclosure. Such embodiments of the inventive subject matter maybe referred to herein individually or collectively by the term“invention” merely for convenience and without intending to voluntarilylimit the scope of this application to any single invention or inventiveconcept, if more than one is, in fact, disclosed. Thus, althoughspecific embodiments have been illustrated and described herein, anyarrangement calculated to achieve the same purpose may be substitutedfor the specific embodiments shown. This disclosure is intended to coverany and all adaptations or variations of various embodiments.Combinations of the above embodiments, and other embodiments notspecifically described herein, will be apparent to those of skill in theart upon reviewing the above description.

What is claimed is:
 1. A colorimetric or fluorometric method ofdetermining the percentage of inhibition of Lp-PLA2 activity, the methodcomprising: colorimetrically or fluorometrically detecting Lp-PLA2activity from a first blood sample that is taken from the subject at afirst time and diluted less than 33 times; colorimetrically orfluorometrically detecting Lp-PLA2 activity from a second blood samplethat is taken from the subject at a second time one hour or more afterthe first time and diluted less than 33 times; and detecting greaterthan 30% inhibition of Lp-PLA2 activity between the first and secondblood samples by comparing the activity of the Lp-PLA2 between the firstand second blood samples, indicating that the subject has taken a drugthat inhibits Lp-PLA2.
 2. The method of claim 1, further comprisingpreparing a solution comprising a substrate for Lp-PLA2 having acolorimetric or fluorometric detectable moiety.
 3. The method of claim1, wherein the second blood sample is taken after the subject has beenadministered a drug that inhibits Lp-PLA2.
 4. The method of claim 1,wherein detecting greater than 30% inhibition of Lp-PLA2 activitycomprises detecting greater than 90% inhibition of Lp-PLA2 between thefirst and second blood samples
 5. The method of claim 1, whereindetecting greater than 30% inhibition of Lp-PLA2 activity comprisesdetecting 85-95% inhibition of Lp-PLA2 between the first and secondblood samples.
 6. The method of claim 1, wherein the first and secondblood samples comprise blood plasma or blood serum samples.
 7. Themethod of claim 1, wherein colorimetrically or fluorometricallydetecting Lp-PLA2 activity from the first and second blood samplescomprises detecting Lp-PLA2 activity within a dynamic range of 100-foldor greater.
 8. A method of clinically monitoring a patient to assess theefficacy of an inhibitor of lipoprotein-associated phospholipase A2(Lp-PLA2), the method comprising: receiving a sample from an animal thathas been administered an Lp-PLA2 inhibitor; and colorimetrically orfluorometrically detecting greater than 30 percent inhibition of Lp-PLA2from the sample by contacting the sample with a solution comprising asubstrate for Lp-PLA2.
 9. The method of claim 8, whereincolorimetrically or fluorometrically detecting greater than 30 percentinhibition comprises detecting greater than 70% inhibition.
 10. Themethod of claim 8, wherein colorimetrically or fluorometricallydetecting greater than 30 percent inhibition comprises detecting atleast 85-75% inhibition.
 11. The method of claim 8, whereincolorimetrically or fluorometrically detecting greater than 30 percentinhibition comprises detecting 85-75% inhibition.
 12. The method ofclaim 8, wherein colorimetrically or fluorometrically detectingcomprises contacting the sample with a solution so that the sample isdiluted less than 33 fold.
 13. The method of claim 8, wherein thesubstrate for Lp-PLA2 includes a colorimetrically or fluorometricallydetectable moiety.
 14. The method of claim 8, wherein receiving a samplecomprises receiving a blood plasma or blood serum sample.
 15. The methodof claim 8, wherein colorimetrically or fluorometrically detectingcomprises detecting inhibition of Lp-PLA2 from a plurality of samplesobtained from the animal at more than one time point before and afteradministration of Lp-PLA2 inhibitor.
 16. The method of claim 8, whereincolorimetrically or fluorometrically detecting comprises comparing theactivity of Lp-PLA2 from a plurality of samples including at least onesample obtained from the animal prior to the administration of Lp-PLA2inhibitor.
 17. The method of claim 8, wherein the substrateconcentration is between about 53 μM to about 1125 μM.
 18. The method ofclaim 8, wherein the substrate concentration is less than 10 times theKm of Lp-PLA2 for the given substrate.
 19. The method of claim 8,wherein the animal is human.
 20. A method of determining inhibition oflipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme activity from asample, the method comprising: preparing a solution comprising asubstrate for Lp-PLA2; contacting a sample from an animal that has beenadministered an Lp-PLA2 inhibitor, wherein the sample is diluted lessthan a 33 fold by contact with the solution; and colorimetrically orfluorometrically detecting Lp-PLA2 activity.
 21. The method of claim 20,wherein colorimetrically or fluorometrically detecting Lp-PLA2 activitycomprises detecting greater than 30 percent inhibition.
 22. The methodof claim 20, wherein colorimetrically or fluorometrically detectingLp-PLA2 activity comprises detecting at least 85-95% inhibition.
 23. Themethod of claim 20, wherein contacting the sample from the animalcomprises contacting a blood plasma or blood serum sample.
 24. Themethod of claim 20, wherein colorimetrically or fluorometricallydetecting comprises detecting activity of Lp-PLA2 from a plurality ofsamples obtained from the animal at more than one time point afteradministration of Lp-PLA2 inhibitor.
 25. The method of claim 20, whereincolorimetrically or fluorometrically detecting comprises comparing theactivity of Lp-PLA2 from a plurality of samples including at least onesample obtained from the animal prior to the administration of Lp-PLA2inhibitor.
 26. The method of claim 20, wherein the substrateconcentration is between about 53 μM to about 1125 μM.
 27. The method ofclaim 20, wherein the substrate concentration is less than 10 times theKm of Lp-PLA2 for the given substrate
 28. The method of claim 20,wherein the animal is human.
 29. The method of claim 20, whereincolorimetrically or fluorometrically detecting Lp-PLA2 activitycomprises detecting Lp-PLA2 activity within a dynamic range of close to100-fold.
 30. A colorimetric or fluorometric method of detecting greaterthan 30% inhibition of lipoprotein-associated phospholipase A2 (Lp-PLA2)enzyme, the method comprising: preparing a solution comprising asubstrate for Lp-PLA2; contacting a sample from an animal that has beenadministered an Lp-PLA2 inhibitor, wherein the sample is diluted lessthan 33-fold; colorimetrically or fluorometrically detecting Lp-PLA2activity.
 31. The method of claim 30, wherein colorimetrically orfluorometrically detecting Lp-PLA2 activity comprises detecting at least85-95% inhibition.
 32. The method of claim 30, wherein contacting thesample from the animal comprises contacting a blood plasma or bloodserum sample.
 33. The method of claim 30, wherein colorimetrically orfluorometrically detecting comprises detecting inhibition of Lp-PLA2from a plurality of samples obtained from the animal at more than onetime point after administration of the Lp-PLA2 inhibitor.
 34. The methodof claim 30, wherein colorimetrically or fluorometrically detectingcomprises comparing the activity of Lp-PLA2 from a plurality of samplesincluding at least one sample obtained from the animal prior to theadministration of Lp-PLA2 inhibitor.
 35. The method of claim 30, whereinthe substrate concentration is between about 53 μM to about 1125 μM. 36.The method of claim 30, wherein the substrate concentration is less than10 times the Km of Lp-PLA2 for the given substrate
 37. The method ofclaim 30, wherein the animal is human.
 38. The method of claim 30,wherein colorimetrically or fluorometrically detecting Lp-PLA2 activitycomprises detecting Lp-PLA2 activity within a dynamic range of 100-foldor greater.